Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident

MacKinnon, Ralph; Slater, David; Pukk-Härenstam, Karin; Schwarz, Ulrica von Thiele; Stenfors, Terese

doi:10.1016/j.bja.2021.07.024

Cited by 9 publications

(7 citation statements)

References 25 publications

(22 reference statements)

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“…In the immediate aftermath of the Manchester Arena Attack the nearby paediatric MTC demonstrated both resilient elements and a series of adaptations to improve patient outcomes during the MCI. 3 During the initial response to the attack twenty-two children aged between eight to fteen years and ve parents presented with blast injuries to the paediatric MTC. 4 One child died in the Paediatric Emergency Department (PED), fourteen children were admitted, four going directly to the operating theatres and six to the Paediatric Intensive Care Unit (PICU).…”

Section: Introductionmentioning

confidence: 99%

A Functional Resonance Analytical Methodology exploration of the essential functions of a paediatric major trauma centre responding to a mass casualty incident

MacKinnon,

Slater,

Jenner

et al. 2024

Preprint

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Background Functional Resonance Analytical Methodology (FRAM) is a systematic approach to model and explore how complex systems adapt to variations and to understand resilient properties in the face of perturbations. Mass Casualty Incidents are rare but can significantly stress healthcare systems. The aim of this study was to use FRAM to create a model of a paediatric trauma system during the initial response to the Manchester Arena Attack to provide resilience-based insights for the management of future Mass Casualty Incidents (MCI). Methods Qualitative interviews in the immediate aftermath of a terrorist bombing, were followed up with further in-depth probing of subject matter experts to create a validated and verified FRAM model. This model was compared with real incident data, then simplified for future studies. Results A Work As Imagined (WAI) model of how a paediatric emergency department provided resilient healthcare for MCI patients from reception and resuscitation to definitive care is presented. A simplified model focussing upon the pathway for the most severely injured patients that will facilitate the simulation of a myriad of potential emergency preparedness resilience response scenarios is also presented. Conclusions The systematic approach undertaken in this study has produced a model of a paediatric trauma system during the initial response to the Manchester Arena Attack, providing key insights on how a resilient performance was sustained. This modelling may provide an important step forward in the preparedness and planning for future MCIs.

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Section: Introductionmentioning

confidence: 99%

A Functional Resonance Analytical Methodology exploration of the essential functions of a paediatric major trauma centre responding to a mass casualty incident

MacKinnon,

Slater,

Jenner

et al. 2024

Preprint

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“…Safety has been described as a dynamic non-event [ 3 ] and as something that is constantly present in professionals’ work processes. Though resilience is not directly observable, it may be possible to identify its emergence in everyday work, where organizations, teams and professionals manage complex situations through anticipating, monitoring, responding and learning [ 4 , 5 ]. Resilience engineering started as a theoretical model, highlighted with clinical examples, but there are now a number of studies calling for more rigorous qualitative research, linking the concepts of resilience engineering to concrete strategies for everyday practice among teams and managers [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence, resilient performance is dependent on the adaptive capacity of frontline staff managing both the gap between WAI and reality and the challenges that emerge when everyday work is done in a complex adaptive system. This capacity relies on adaptations that professionals perform as a part of everyday work [ 2 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, insight into prerequisites for successful task management, NTS and the importance of adaptive coordination is growing. However, little is known about the underlying organizational and situational circumstances that trigger and support adaptive coordination and we have only begun to explore the effects that variability in adaptation of NTS have on safety [ 5 , 27 ]. Such knowledge may contribute to a deeper understanding of how to design care systems for safe clinical practice [ 1 , 14 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study

Olin

Klinga

Ekstedt

et al. 2023

BMC Health Serv Res

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Background Safety has been described as a dynamic non-event and as constantly present in professionals’ work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety – testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. Methods Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. Results During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. Conclusion Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation.

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“…Functional resonance methodology [5], is being increasingly employed in healthcare studies precisely because it can address these more complex situations. Recent examples range from learning the lessons from a mass casualty incident, for improving the response of a paediatric major casualty centre [6], to examining the effectiveness of the UK's response to the COVID-19 pandemic [7,8]. There are now also two extensive literature reviews of the use of the FRAM approach [9,10], which give an excellent overview of the extent and effectiveness of the methodology.…”

Section: Introductionmentioning

confidence: 99%

Optimising the Performance of Complex Sociotechnical Systems in High-Stress, High-Speed Environments: The Formula 1 Pit Stop Test Case

Slater¹,

Hill²,

Kumar

et al. 2021

Applied Sciences

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In analysing the performance of complex sociotechnical systems, of particular interest is the inevitable and inherent variability that these systems exhibit, but can normally tolerate, in successfully operating in the real world. Knowing how that variability propagates and impacts the total function mix then allows an understanding of emergent behaviours. This interdependence, however, is not readily apparent from normal linear business process flow diagrams. An alternative approach to exploring the operability of complex systems, that addresses these limitations, is the functional resonance analysis method (FRAM). This is a way of visualising a system’s behaviour, by defining it as an array of functions, with all the interactions and interdependencies that are needed for it to work successfully. Until now this methodology has mainly been employed as a qualitative mind map. This paper describes a new development of the FRAM visualisation software that allows the quantification of the extent and effects of this functional variability. It then sets out to demonstrate its application in a practical, familiar test case. The example chosen is the complex sociotechnical system involved in a Formula 1 pit stop. This has shown the potential of the application and provided some interesting insights into the observed performances.

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Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident

Cited by 9 publications

References 25 publications

A Functional Resonance Analytical Methodology exploration of the essential functions of a paediatric major trauma centre responding to a mass casualty incident

A Functional Resonance Analytical Methodology exploration of the essential functions of a paediatric major trauma centre responding to a mass casualty incident

Exploring everyday work as a dynamic non-event and adaptations to manage safety in intraoperative anaesthesia care: an interview study

Optimising the Performance of Complex Sociotechnical Systems in High-Stress, High-Speed Environments: The Formula 1 Pit Stop Test Case

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