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Ce document a été généré automatiquement le 30 avril 2019. Pistes est mis à disposition selon les termes de la licence Creative Commons Attribution-Pas d'Utilisation Commerciale-Pas de Modification 4.0 International. Transformation du travail, transformation du métier : quels impacts sur la sa...

This study aims to describe how anesthesia teams handle unforeseen events that may affect the patients' health. More precisely, it investigates the mechanisms of decisions made by anesthesia teams to manage unthought-of situations, i.e. situations that have not been foreseen as "possible" ones before their occurrence. An empirical study, based on the analysis of simulated situations, was conducted in a pediatric anesthesia service of a university hospital in France. The results highlighted three ways of managing unthought-of situations (determined management, cautious management and overwhelmed management). They support the hypothesis of a collective cognitive trade-off, whereby teams would behave as virtual operators, with their own collective trade-off between "understanding" and "doing". The discussion of the results questions the assessment criteria, the safety perspectives we adopt and the possible ways to improve the management of unforeseen situations.

Activités est mis à disposition selon les termes de la licence Creative Commons Attribution-Pas d'Utilisation Commerciale-Pas de Modification 4.0 International.

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Patient safety is a major issue and a challenge to be addressed by public policy. New alternative approaches are currently being developed within the international community. In particular, these new approaches include the concept of "resilience" In this context, this literature review presents this new trend called "resilience engineering". It is based on scientific articles in French and English identified in two large databases (Cairn and Science Direct). The overall objective was to determine how this concept can help us to understand the functioning of the healthcare system and propose new ways to improve patient safety. Three main characteristics of the resilience approach were identified, supporting the value of resilience engineering in healthcare systems. To illustrate these results, the review presents an illustrative example in the field of anaesthesia. In conclusion, it is now clear that traditional approaches to safety have many limitations for risk prevention in healthcare: work organization must promote adaptive strategies built by healthcare teams. The new concept of "resilience" appears to be a relevant tool to achieve this goal.