Organizational strategies used by operations and maintenance personnel at two US nuclear power plants are compared with those described by the Berkeley group in their extensive high reliability organization studies. Using the method of strategic analysis, we show that the two organizations use quite different strategies in their search for reliability and effectiveness. The focus on the coordination of workers and structuring of tasks reveals areas not completely dealt with in previous HRO-related studies. It is argued that adopting a complementary approach in which elements of both methods are selectively applied may lead to an analytic framework of greater theoretical and explanatory power.

The 2009 H1N1 pandemic had considerable impact on risk perceptions, vaccination campaigns, and global health governance. In this context, risk communication issues have been probably the most puzzling and the least understood in retrospect. This article reviews the current knowledge on the following issues: risk and pandemic perceptions; vaccination perceptions and practices; rumors and rumor propagation; and health risk communication. It also highlights the research gaps in these areas that remain to be further explored in the future.

This article looks back over two decades of work pioneered by Todd LaPorte and colleagues, under the banner of High Reliability Theory (HRT). The article revisits the American roots of the Berkeley-based group and comments on its early and decisive fieldwork choices. It revisits some of the elements that emerged through the controversy around findings and implications of HRT. It discusses the legacy of HRT and the ethnographical impetus given to 'normal operations' studies. The use of ethnographic and sociological methodologies gave new vitality to the study of high-risks organizations.

Pandemic response takes place in distributed, uncertain, and high-tempo environments. These conditions require public health agencies to rapidly generate and roll out publicly accountable responses in the face of incomplete and ambiguous evidence. To perform under these conditions, public health organizations have devised several tools to support decision making and response. This article examines two such tools that debuted during the 2009 H1N1 outbreak-the 2005 International Health Regulations and influenza pandemic planning. Relying on an international network of researchers who gained access to lead public health agencies in advance of the 2009 pandemic, this study draws on several forms of data-primary documentation, interviews, and an extended workshop with key officials-that were collected as the pandemic unfolded. With this unique dataset, we analyze the performance of the International Health Regulations and pandemic influenza plans from a "sensemaking" perspective. We find that insufficient attention to both the complexities and time horizons involved with adequate sensemaking limited the ability of both tools to fully meet their goals. To improve organizational performance during global pandemics, the sensemaking perspective calls attention to the importance of informal venues of informationsharing and to the need for decisionmakers to continually update planning assumptions.

IntroductionResilient healthcare (RHC) is an emerging area of theory and applied research to understand how healthcare organisations cope with the dynamic, variable and demanding environments in which they operate, based on insights from complexity and systems theory. Understanding adaptive capacity has been a focus of RHC studies. Previous studies clearly show why adaptations are necessary and document the successful adaptive actions taken by clinicians. To our knowledge, however, no studies have thus far compared RHC across different teams and countries. There are gaps in the research knowledge related to the multilevel nature of resilience across healthcare systems and the team-based nature of adaptive capacity.This cross-country comparative study therefore aims to add knowledge of how resilience is enabled in diverse healthcare systems by examining adaptive capacity in hospital teams in six countries. The study will identify how team, organisational and national healthcare system factors support or hinder the ability of teams to adapt to variability and change. Findings from this study are anticipated to provide insights to inform the design of RHC systems by considering how macro-level and meso-level structures support adaptive capacity at the micro-level, and to develop guidance for organisations and policymakers.Methods and analysisThe study will employ a multiple comparative case study design of teams nested within hospitals, in turn embedded within six countries: Australia, Japan, the Netherlands, Norway, Switzerland and the UK. The design will be based on the Adaptive Teams Framework placing adaptive teams at the centre of the healthcare system with layers of environmental, organisational and system level factors shaping adaptive capacity. In each of the six countries, a focused mapping of the macro-level features of the healthcare system will be undertaken by using documentary sources and interviews with key informants operating at the macro-level.A sampling framework will be developed to select two hospitals in each country to ensure variability based on size, location and teaching status. Four teams will be selected in each hospital—one each of a structural, hybrid, responsive and coordinating team. A total of eight teams will be studied in each country, creating a total sample of 48 teams. Data collection methods will be observations, interviews and document analysis. Within-case analysis will be conducted according to a standardised template using a combination of deductive and inductive qualitative coding, and cross-case analysis will be conducted drawing on the Qualitative Comparative Analysis framework.Ethics and disseminationThe overall Resilience in Healthcare research programme of which this study is a part has been granted ethical approval by the Norwegian Centre for Research Data (Ref. No. 8643334 and Ref. No. 478838). Ethical approval will also be sought in each country involved in the study according to their respective regulatory procedures. Country-specific reports of study outcomes will be produced for dissemination online. A collection of case study summaries will be made freely available, translated into multiple languages. Brief policy communications will be produced to inform policymakers and regulators about the study results and to facilitate translation into practice. Academic dissemination will occur through publication in journals specialising in health services research. Findings will be presented at academic, policy and practitioner conferences, including the annual RHC Network meeting and other healthcare quality and safety conferences. Presentations at practitioner and academic conferences will include workshops to translate the findings into practice and influence quality and safety programmes internationally.

The article will present some possible explanations of the difficulty to bridge research and practice in the domain of risk management. A first block of reasons has to do with the very content of the analyses themselves. Of great importance is also the time chosen for them to be carried out. The second argument will bring to the foreground the difficulty for a lot of fruitful research to permeate into management spheres. One way to reconcile experts, scholars and decision makers may come from new attention devoted to organisational design and formal structures. This calls for the study of normal operations as opposed to relying too exclusively on accident cases and crisis situations. We believe that this perspective can help us improve our level of understanding of complex organisations, because it focuses on the duality of organisational life: the dark side and the bright side, always tightly coupled.

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The topic of transparency has received increasing academic interest in recent years. Transparency can be interpreted as conducting affairs in the open, being subject to public scrutiny, or admitting to problems when they arise. This chapter analyses transparency in disclosing adverse events to the public in Norway. We use the widely publicized Daniel case to show the communication between the regulator and the public, discussing key elements of transparency in the healthcare setting, including the role of media. The Daniel case describes an accidental tonsillectomy characterized by cover-up, failure of the initial regulatory and hospital follow-up, coming to a head when media shone a spotlight on the case. The media coverage caused social amplification of the risk communication resulting in regulatory follow-up having to apply new forms of transparency strategies to rebuild trust in the public. By using the Daniel case as emblematic of Norwegian risk communication strategies in health care, improvements should be made along the lines of direct and adequate information exchange according to patient rights, and efforts to foster open and transparent regulatory and organizational cultures to ensure public trust.