PROCESS SAFETY MANAGEMENT AND LOSS PREVENTION

Process Safety Management and Loss Prevention



Process Safety Management and Loss Prevention

Introduction

Conclusion

PROCESS SAFETY MANAGEMENT AND LOSS PREVENTION

Process Safety Management and Loss Prevention

Process Safety Management and Loss Prevention

Introduction

This paper proposes that institutionalizing reflexive practice is the crux of progressive change and practical safety in highly complex organizational settings. We use patients' safety in hospital-based health care as the empirical context where such reflexive space can (or should) be realized. As we present our data and argument, we sketch the role of an outsider-catalyst (or “clinalyst”). This person deploys data of in situ clinical practices to enable frontline practitioners to consider and then problem-solve complex organizational issues. The most important and challenging issue that confronts practitioners is patients' safety. Safety demands constant assessment of the effectiveness and efficacy of established treatment approaches, inevitably involving careful in situ experimentation, adaptation and at times, transgression (Bevan, 2006,, 517).

Process Safety Management and Loss Prevention

To date, health care policy makers, managers and researchers have seen patient safety as contingent on the degree to which systems, technologies and regulations are undergirded by and designed on the basis of formal evidence derived from large-sample studies. These systems, technologies and regulations are imposed on frontline clinicians on the assumption they can guarantee safety if only fully adhered to. But these “safety resources” can rarely be adopted and deployed as intended, because to do so may heighten risk and lead to errors. For example, formal limits placed by policy guidelines on the number of units of blood product that patients are to receive to reduce waste can lead to adverse clinical consequences if such advice is followed too rigidly. Examples of such guidelines requiring “careful interpretation” to match local circumstances and result in benefit for the patient abound (Bevan, 2006,, 517).

In all, what is evident is that there is not a direct and unproblematic translation of formal safety resources into practice . On the contrary, practitioners need to engage in complex “articulation work” to make systemic, technological and regulatory resources relevant to in situ processes . This articulation work may be accompanied by “learning work”, or processes by means of which practitioners derive knowledge from applying formal resources to in situ processes, and navigating between those resources and the complexities and unpredictabilities of everyday processes and circumstances . Such learning work, however, is inevitably contingent on reflexivity. Reflexivity becomes de rigueur when frontline practitioners need to mediate the complexities of their practice and the ideal-type resources and regulations with and through which they seek to structure their practices.

The present paper presents a case study that shines a light on two kinds of reflexive processes: the in situ articulation of formal resources to unfolding practice and the re-design of those formal resources using knowledge thus produced. True, considerable research has already illuminated the “labour” frontline workers need to perform to manage the gap between formal guidelines and technologies on the one hand, and the vicissitudes of in situ practice on the other hand ...