Coping with the unforeseen in surgical work

OBJECTIVE The purpose of this study was to investigate how staff working in the perioperative domain copes with unforeseen events and in what way, if at all; they are supported in this by formal systems such as information systems. DESIGN Case study. We conducted our study in the Department of Surgery in a large academic hospital in Norway. The department consists of eight operating rooms for planned surgery. The study included observations and interviews, in addition to one design workshop with health personnel. We focused on planned surgery. RESULTS Our observations showed that unforeseen events that cause deviations from plans are characteristic and that staff apply different coping strategies to make the plan work regardless. Support of these coping strategies by formal systems is poor. DISCUSSION We used the concept of high-reliability organisations as proposed by Weick and Sutcliffe, 2007, to analyse the observed coping strategies. The coping strategies can be seen as examples of the principles for managing the unexpected that Weick and Sutcliffe propose. IT support for this must include both awareness-creating systems and systems that enable workers to control the effects of unforeseen events once they have occurred.

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