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Implementation systems that support resilient performance
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
The third general form of adaptive system breakdown, noted by Woods and Branlat (2011), is also highlighted by this case. Different groups appeared to be stuck in past models, even as evidence became available that these needed to be revised. First, several groups in the implementation system had mental models of nurses’ work that were shown to be mismatched to how nurses actually monitor for physiological decompensation. This was also true of models of physicians’ work not matching how they actually anticipated physiological decompensation. In addition, research results in general, confirmed by the results in this particular case, on how technology supports or hinders anticipation, did not match several groups’ models of the impact of alarm system design on cognitive factors. However, all these mental models that were challenged or refuted outright by empirical findings and relevant literature were resistant to revision (Rayo and Moffatt-Bruce 2015). The irony is that the implementation system is in principle tasked with aiding organizational learning. This persistence of “stale models” and the fragmentation across roles 1) reduced the organization’s ability to recognize the gap and the opportunity to improve, 2) slowed the organization’s response once recognized, and 3) increased the cost of change.
Making an accurate assessment
Published in Helen Taylor, Ian Stuart-Hamilton, Assessing the Nursing and Care Needs of Older Adults, 2021
Much has been written about observational information gleaned by expert nurses from their patient, often even before that patient has demonstrated any overtly recognisable symptoms.7,35,36 It is important to explore how this occurs in order to gain an insight into how errors may occur with such judgements. An exploration by Gardner37 of the work of cognitive scientists such as Johnson-Laird, Kahneman and Tversky indicates that early cognitive models of human beings as logical and rational thinkers require some reconsideration. Findings suggest that people do not simply apply the same rules of logic regardless of the actual nature of the problem. Gardner37 explains Johnson-Laird’s theory of how individuals use mental models as a necessary component of syllogistic reasoning: One succeeds on problems to the extent that one can construct mental models that represent the relevant information in an appropriate fashion and use these mental models flexibly…. Logic cannot serve as a valid model of how most individuals solve most problems all of the time.(p. 370) This implies that individuals use their experience of the real world to construct mental models, which means that although logic may have some place in some instances, not all decisions will appear logical, or possibly rational. This has been explored in more detail in Chapter 4.
Non-Technical Skills for ENT Surgeons
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Simon Paterson-Brown, Stephen R. Ell
This is the free exchange of information pertinent to the situation, from all members of the team, and a complete picture is best gained if the atmosphere is easy and unstrained. This is not the didactic surgeon telling the team how it is and who should do what in a bombastic way, brooking no argument. Each member of the team brings a personal understanding of what might be required of them, but not how that might fit in with other members of the team; therefore, individuals tell the rest of the team their thoughts, concerns and impressions, that they feel are important to their role in the team. Clarity is achieved by questions and answers; however, reticent members of the team may need to be ‘drawn out’ and asked directly if there is anything they would like to say, or ask. Information given by one member of the team may trigger further information or questions from another and sufficient time needs to be allocated for this. All relevant concerns should be shared. Holding back information, or minor concerns, because these are thought to be unimportant, may not be helpful, since a situation may arise when these concerns become highly important. Experienced professionals develop a ‘sixth sense’ when something is about to go wrong and sensing this may initiate checking emergency equipment, such as additional means of intubation, or that the crash trolley is well stocked and has serviceable defibrillators. This process of exchanging information is necessary to develop a ‘shared mental model’ of the situation.
Response to: ‘System dynamics modeling to understand mental model of public humiliation in medical education’
Published in Medical Teacher, 2023
Jarukasemkit et al. (2022) generate a mental model of public humiliation, using a narrative review of relevant literature to produce a causal loop diagram and report that this was validated using medical students and educators. It is not clear from the text whose mental model they are representing. The first part, ‘No Pain, No Gain’ appears to propose the mental model of the abusive educator. The perspective of the model shifts with the addition of the second and third parts, adding a more objective view on the outcomes of verbal abuse on student performance. The model therefore attempts to show the perspective of the abusive educator and an external view simultaneously, impeding its ability to show either. Together, this makes the perspective of the mental model, and hence its utility in conceptualising and changing medical education, unclear.
Pediatric rapid response system innovations
Published in Hospital Practice, 2021
Lindsey Troy, Mary Burch, Jonathan G. Sawicki, Jared W. Henricksen
Standardization of care algorithms can assist in developing and maintaining a shared mental model of care that may bolster hospital improvement efforts [44]. The American Heart Association’s Pediatric Advanced Life Support (PALS) and Adult Cardiovascular Life support (ACLS) training programs, for example, rely heavily on algorithms to guide care and mitigate error during acute resuscitation events [45,46]. These clinical decision support tools provide a shared mental model that can help optimize team performance when faced with a decompensated patient. These algorithms are typically developed for well-defined physiologic processes and can help guide patient care during a specific period of time [47]. They help facilitate communication and tasks for the multidisciplinary team to follow [48,49]. The use of algorithms has been associated with improved adherence to resuscitation guidelines, shorter time to life-saving interventions, and decreased mortality in severely ill patient subsets [50,51].
Managed care and innovation in healthcare management: a Brazilian experience
Published in International Journal of Healthcare Management, 2021
Marcelo Antunes Marciano, Guilherme Luís Roehe Vaccaro, Annibal José Roris Rodriguez Scavarda do Carmo, Fabiano de Lima Nunes, Cristine Hermann Nodari
Future research can investigate these dilemmas as well as the possibility of resolving them through the application of these new concepts. Studies can also be conducted to verify whether it is feasible to use innovations such as ‘how to think health’ (mental models) and how to manage health through the verification of systemic relationships between actors. Therefore, further studies are required to better determine the profile range of Brazilian health plan operators and hospitals, and their peculiarities regarding type, demographic coverage area and cultural issues. Such studies may investigate the management criteria used by health plan operators and hospitals along with mapped processes and operations, documented and implemented strategic plans, deployed quality management systems and systems certified by external bodies. Studies evaluating the competitive edge and economic and financial conditions of these organisations, as well as the satisfaction or value they provide to their beneficiaries, are also subject for further research.