9Occupational Applications 10 We adopted a system dynamics approach to simulate dynamic factors affecting dispensing backlog 11 and dispensing errors in a hospital pharmacy system. This approach allowed us to simulate diverse 12 scenarios (hospital winter pressures and differing staffing arrangements) and to understand the 13 potential unintended impact of rework due to dispensing errors, which is often missing from model-14 based approaches. The results revealed the impacts of key factors (high workload, staff capacity, 15 backlog, incoming prescriptions, errors, and delay) on system performance and safety within hospital 16 pharmacies. Use of a system dynamics model can provide pharmacy management with practical tools 17 to understand the unintended adverse effects of dynamic factors that contribute to dispensing backlog 18 and errors. 19 Technical Abstract 20 Background (or Rationale): The traditional hospital pharmacy staffing management model does not 21 account for the complex interactions of social, technical, and environmental factors that can affect 22 performance and safety. Conventionally, workload and dispensing errors within the hospital 23 pharmacy system have been analysed on a factor-by-factor level, using linear and static approaches 24 that ignore feedback mechanisms. 25Purpose: We aimed to explore the potential of a system dynamics approach to modelling staffing 26 level management in a hospital pharmacy. 27th Methods: Qualitative and quantitative system dynamics models were created to simulate dynamic 28 aspects contributing to dispensing backlog and errors in a hospital pharmacy. A baseline scenario was 29 tested in a "normal" condition, and three different staffing level scenarios (fixed, flexible, and 30 equivalent-fixed) were tested in an extreme condition (hospital winter pressures). 31 Results: During hospital winter pressures, the unintended negative effect on rework due to dispensing 32 errors made it more challenging to deal with demand variability. Findings from the scenario-based 33 simulations revealed that a flexible staffing level arrangement, which dynamically adjusts the number 34 of staff to demand variability during winter pressure, is less effective in reducing the amount of 35 rework than maintaining an equivalent-fixed staffing level. Dispensing backlog during winter pressure 36 can be averted or substantially diminished by proactively employing an equivalent-fixed staffing level 37 that accounts for total staff capacity needed vis-à-vis the current workload. Premature release of extra 38 staff and delayed calling of additional staff from wards can have significant impacts on backlog. 39 Conclusions: Our results demonstrate that system dynamics can provide practical insights into 40 staffing level management in a hospital pharmacy, by accounting for dynamic factors causing 41 dispensing backlog and errors and presenting decision-makers with a holistic understanding of 42 elements affecting system safety and performance. 43 44
System Dynamics has the potential to study the aspects of complex systems including its likely effect of modifications to structural and dynamic system properties that cannot be achieved with traditional approaches. This paper presents a review of literature addressing safety issues using system dynamics across safety-critical domains. Forty studies were included and classified based on a customised human factors safety taxonomy framework. The thematic analysis of the literature resulted in five themes: external factors, organisational influences, unsafe supervisions, preconditions for unsafe acts and unsafe acts. The findings suggest that using system dynamics can be a potential tool in improving safety. This can be achieved through improved decision-making by basing it on system analysis, analysing past behavioural events in a modelling structure to plan effective safety policies, as well as looking at a holistic approach when analysing accidents.
Targeted killing is a cornerstone of counter-terrorism strategy, and tactical mistakes made by militant groups are endemic in terrorism. Yet, how do they affect a militant group's suicide bomber deployment? Since joining Al-Qaeda, Al-Shabaab has carried out various types of suicide attacks on different targets. Using a uniquely constructed dataset, I introduce two typologies of suicide bomber detonation profilessingle and multipleand explore the strategic purposes these have served for the group during multiphasic stages following targeted killings against the group's leadership and targeting errors committed by Al-Shabaab. The findings reveal that targeted killing has the opposite effect of disrupting suicide attacks, instead, leading to a rapid proliferation of unsophisticated single suicide attacks against civilian and military targets to maintain the perception of the group's potency. Thus, I argue that targeting errors made by Al-Shabaab have a more serious detrimental effect on its deployment of suicide attacks than any counter-terrorism measure.
Globally, the spread and use of suicide bombing attacks have become a regular occurrence. Security studies literature focuses primarily on conventional suicide bombing attacks. However, a growing trend has been observed on the adoption of complex suicide attacks. Using Al-Shabaab as a case study, this paper investigates the phenomenon of complex suicide attacks. We explore the tactical differences of complex suicide attacks vis-à-vis simple attacks in terms of its target goal, discriminative lethality, and delivery method. The paper relies on a uniquely constructed dataset of the group's suicide operations, employing a variety of data collection techniques. The findings reveal that, inter alia, complex suicide attacks reduce civilian casualties compared to simple suicide attacks.Contrary to the group's intent and official guidelines to target foreign entities; findings illustrate that domestic targets bear the brunt of most complex suicide attacks. These findings have the potential to contribute to counter-terrorism strategies and be adopted by concerned states in order to effectively protect significant loss of lives and destruction of property resulting from suicide terrorism.
With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that permits decision-makers to better understand the complexity, test various strategies and guide effective changes. System Dynamics (SD) modelling is an effective approach that can aid strategic decision-making in healthcare systems but has been underutilised partly due to the challenge of engaging healthcare stakeholders in the modelling process. This paper, therefore, investigates the applicability of a participatory SD approach based on healthcare workers' perspectives on ease of use (usability) and usefulness (utility). The study developed an interactive simulation dashboard platform which facilitated participatory simulation for exploring various hospital pharmacy staffing level arrangements and their impacts on interruptions, fatigue, workload, rework, productivity and safety. The findings reveal that participatory SD approach can enhance team learning by converging on a shared mental model, aid decision-making and identifying trade-offs. The implications of these findings are discussed as well as experience and lessons learned on modelling facilitation.
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