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E47: Improving procedures via resilient skills - leveraging resilience engineering (quickisode) · Safe As Podcast

• 0:07
  How can procedures be improved to expand and support human
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  capacities? How can they facilitate
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  resilience skills? Welcome to the next quickest
• 0:16
  site of SOFAS. The study from Soren ET al, 2015
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  is titled Exploring Synergies between the Design Procedures
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  and the Development of Resilience Skills Publishing
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  Proceedings of the 6th Resilience Engineering
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  Symposium. Resilience skills are the skills
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  and capabilities of people to respond to unexpected or
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  ambiguous situations, resource constraints, or goal conflicts.
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  They help people adapt safely and efficiently.
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  So, let's look at how procedures can help facilitate these safe
• 0:47
  and efficient resilient adaptations.
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  I'm reading from three columns. First is the procedural criteria
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  that enhances resilience skills, next is why we should focus on
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  that element, and then the third are examples of how this
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  criteria was either applied or found in a real world example.
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  So one are the goals of the activity stated in the
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  procedure. This is important because for
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  training resilient skills, the statement of clear goals is
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  important since it provides a basis for observing how trainees
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  trade off goals. And in their example, they found
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  procedures simply stated that the administration should be
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  safe and correct, so not very helpful. 2 Are the minimum
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  inputs and preconditions required to start the task
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  stated? Why?
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  Because the identification of the inputs and preconditions is
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  crucial for the training of resilience skills.
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  If these aren't available, workers will have to make do
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  using resilience skills to deal with scarcity of resources.
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  And in the example they found this information was actually
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  fragmented over several sections of the procedure.
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  In response, the author suggests grouping inputs and
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  preconditions into a specific section of the procedure could
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  help. Three are the work constraints
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  that can make it difficult to follow the procedure.
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  Actually state in the procedure why work constraints, such as
• 2:11
  the lack of the minimum inputs to start a task push performance
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  out of the design envelope, thus further increasing the need for
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  resilient skills in the first place.
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  For the example, they found the procedure took for granted that
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  ideal working conditions would be in place, and thus it didn't
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  actually mention any work constraints at all.
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  But different work constraints existed, so perhaps things like
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  workload and their resilient skills could be listed in the
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  procedure and included in training sessions.
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  That is actually lists common or expected constraints in the
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  procedure and guides operators on how to adapt to them. 4 Are
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  there over specifications or irrelevant specifications that
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  could be removed from the procedure?
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  Why? Over specification would be
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  detrimental for the training of resilient skills since would
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  facilitate deviant performance that could be in hindsight
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  wrongly interpreted as work as violation or potentially
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  creating a double bond for workers.
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  Like following the procedure and then being blamed for not
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  deviating or not following the procedure and be blamed for
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  deviating. For the example, no examples of
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  overspecifications were found in the sample, but there were
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  sentences that were redundant or unnecessary, like bringing the
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  medications to the patient. Five are the direct relationship
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  with other procedures mentioned. This is important because
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  relationships are important for the scenario based training
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  because a lack of resources for carrying out an interrelated
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  procedure is a work constraint that might actually then demand
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  more resilient skills. For the example, professionals
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  stress that other procedures should have been referenced like
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  the procedure for washing hands. Six other examples of under or
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  no specifications that should have been specified.
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  Why situations of unnecessary or under or no specification
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  possibly mean that resilient skills have been overused in
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  detriment of routine skills. For their example, unnecessary
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  procedural gaps were found like lack of guidance on identifying
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  patient characteristics 7. The situations identified from
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  six have an impact on either safety or efficiency.
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  Why? Unnecessary under or no
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  specification increases the risk of undesired side effects
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  arising from the use of resilient skills.
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  And in their example, they found where a patient wasn't able to
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  swallow oral meds that wasn't actually listed, so the
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  procedure could never have been followed in that situation. 8 To
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  what extent is it possible and worth specifying the situations
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  identified from six? While some of the unnecessary
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  gaps can be filled using action oriented rules, others can be
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  suitable for goal oriented and process oriented rules as they
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  rely on resilience skills to a greater extent.
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  Also, the procedure could state the required resilience steps
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  associated with high variability, especially if there
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  are either safety or efficiency implications.
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  And in their example, professionals indicated action
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  and process rules that could fill most gaps.
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  Like certain visual cues and questions should be made to the
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  patient in order to assess their ability to swallow.
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  These cues and questions should be practised in sessions of
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  scenario based training. This is pretty difficult to
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  explain in the pod, but I really recommend checking out the paper
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  and see if we can help improve your procedures.
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  That's it on this quicker side of safe As.