Affiliations: Centre d'Etudes de l'Emploi (Cee), Noisy-le-Grand, France | CRTD, Cnam, Paris, France | Department of Anesthesiology and Intensive Care, University Hospital, Angers, France | Department of Quality-Risk Assessment, University Hospital Angers, Angers, France | Department of Anesthesiology and Critical Care, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Faculté de Médecine, Paris, France
Note: [] Address for correspondence: Lucie Cuvelier, Centre d'Etudes de l'Emploi (Cee), 29, promenade Michel Simon, 93166 Noisy-le-Grand Cedex, France. Tel.: +33 1 45 92 68 46; Fax: +33 1 44 10 79 34; E-mail: [email protected]
Abstract: Objective: Anticipation and planning are essential steps of risk management but the mechanisms of planning behavior are incompletely understood, especially the factors including collective work. The aim of this research is to understand how anesthetists plan safe solution to perform anesthesia. Methods: A study based on interviews was conducted in two French hospitals. Data processing focused on the main decisions made by 20 anesthetists during two simulated pre-anesthetic consultation. The main decisions made have been identified and the decision criteria have been analyzed. Results: To ensure patient safety, all anesthetists do not plan the same solution. The rejection or the selection of solutions by each physician rests on two types of criteria: the assessment of risks for the patient and the assessment of resources available to handle the situation. For the latter, the knowledge on the individual skills of each and the adoption of “local benchmark practices” play an essential role. Conclusion: Ultra safe performance in highly variable systems cannot be achieved only through standardization but also through the possibility and ability of the subjects to adapt their practices to their own skills and to that of their colleagues. The conditions for the development of this “adaptative safety” are discussed.
Keywords: Decision making, anesthesia, patient safety, human factors, teamwork
