Devices and organizations are designed and regulated in a way that can generate errors that can be related to a certain underestimation of the anaesthesiologist environment's variability and of the patient's states evolution (De Keyser & Nyssen, 1997). Their evolution is also linked to the degree of normalization of deviance (Vaughan, 1996) and to the social control of these migrations. Our concern is to know how these organizational and systemic-related unsafe acts emerge in Argentina’s hospitals, in order to determine what the main ergonomic challenges in the design of devices and work organization are for patient safety and anaesthesiologist’s work improvement in that specific context.
From a theoretical perspective, we believe as Gauthereau (2003) that improving safety implies to think about it as a “social practice”, were many social actors are being involved in a negotiation process, which can or cannot deliver a safe result.
This negotiating activity concerns the rule design process (Reynaud, 1993) but also the devices design process into which ergonomics is most often involved. We also believe, with Gauthereau, heedfulness’ as a way of “challenging the normal, current understanding of things” is necessary to improve safety, in all contexts, and that it is one of the ergonomics roles. This heedfulness’ is much more necessary in contexts like the anaesthesiology in Argentina, where the risks related to expert’s judgment drift are very high, according to some late studies (Gallino, 2006). The drift in practices should be an object of heedfulness, according to what cognitive ergonomics and resilience engineering describe (Rasmussen, 1997; Amalberti, 2006). As a matter of fact, otherwise practices could get closer and closer to the accident-prone zone.
We believe one of the challenges of heedfulness is maintaining the system in the controlled and flexible central zone, without paralyzing the system, and avoiding it to enter the accident zone.
Argentina is a country where no specific research in the field of human factors applied to organizational reliability and industrial risks management is seriously developed. In fact, even if, after some very severe aviation, mine and other industrial accidents, some efforts have been made, we believe the field is almost virgin. This has some good aspects, and some bad ones: we are free to work and develop new approaches of safety, without having to battle against old ideas of safety or to insist on destroying organizational structures that are obsolete; on the other hand, the process of organizational and devices design is not alive, and we have to help its emergence. On the other hand, even if experts in the field of organizational and social management of safety are almost absent in argentine institutions, the context is evolving right now thanks to an important type of actor who generates the momentum for changes and negotiations in order to improve patient and workers safety and health: the “whistle blowers”, well studied by Chateauraynaud & Torny (1999). In fact, some physicians are starting to act on their own to improve safety, without belonging to any negotiating entity listed in Gauthereau’s model.
Therefore, we believe our strategy in the specific argentine context needs to start by understanding the negotiating activities – between sharp-end practice, Management, Regulation Authorities, mass media and public, and research institutions, including whistle blower’s - that already take place between the existing actors in order to assess how they try to improve safety and help them to better succeed next time. This approach can help us better describe what the real situation regarding safety is nowadays in Argentina, were some things are starting to change thanks to individual efforts, even if institutions aren’t really ready for the change. In fact, we had the great opportunity to study the activity of a whistle blower in the field of anaesthesiology. He is an argentine anaesthesiologist, and he has asked us to join him and some of his colleagues in their “lonely battles” to improve safety in his professional field (De Luca, 2005). That’s how this joint work started one year ago, and the present work is a trace of our first collaborative experience.
Con Gabriela Cuenca y Georg, en el 1er congreso de ULAERGO de Santiago de Chile, en 2004
Visitando el laboratorio de Georg y de Enrique Montero en la UNAB de Santiago de Chile (2004)
