Given the complexity of health care and the ‘people’ nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.
The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.
Background:
The phenomenon of clinical negligence claims has rapidly spread to United
States, Canada and Europe assuming the dimensions and the severity of a pandemia. Consequently, the
issues related to medical malpractice need to be studied from a transnational perspective since they
raise similar problems in different legal systems.
Methods:
Over the last two decades, medical liability has become a prominent issue in healthcare policy
and a major concern for healthcare economics in Italy. The failures of the liability system and the
high cost of healthcare have led to considerable legislative activity concerning medical malpractice liability,
and a law was enacted in 2012 (Law no. 189/2012), known as the “Balduzzi Law”.
Results:
The law tackles the mounting concern over litigation related to medical malpractice and calls
for Italian physicians to follow guidelines. Briefly, the law provided for the decriminalisation of simple
negligence of a physician on condition that he/she followed the guidelines and “good medical practice”
while carrying out his/her duties, whilst the obligation for compensation, as defined by the Italian Civil
Code, remained. Judges had to consider that the physician followed the provisions of the guidelines but
nevertheless caused injury to the patient.
Conclusion:
However, since the emission of the law, thorny questions remain which have attracted renewed
interest and criticism both in the Italian courts and legal literature. Since then, several bills have
been presented on the topic and these have been merged into a single text entitled “Regulations for
healthcare and patient safety and for the professional responsibility of healthcare providers”.
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