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A naturalistic decision-making perspective on anaesthetists’ rule-related behaviour

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Abstract

As a widely recognised feature of work activity, procedural violations have been of considerable interest to human factors specialists, and several models have been proposed to aid in understanding their occurrence. A common feature of these models is that they depict violations as being, to a greater or lesser extent, intentional; therefore, rule-related behaviour could be reconceptualised as an exercise in decision-making. In this paper, we examine anaesthetists’ use of rules from the perspective of naturalistic decision-making. Doing so suggests that their rule-related behaviour is a product of the extent to which following a rule is consistent with other principles that guide their decision-making. Observational and interview data from 23 consultant anaesthetists indicated the presence of three such principles: “doing the right thing”; “doing what works in the circumstances”; and “using one’s skills and expertise”. Hence, rule-related behaviour in this setting is better understood as a form of situated action than as the following or breaking of rules per se. We discuss the implications of this view for understanding why violations occur, and how to address them.

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References

  • Alper SJ, Karsh B-T (2009) A systematic review of safety violations in industry. Accid Anal Prev 41(4):739–754

    Article  Google Scholar 

  • Alper SJ, Holden RJ, Scanlon MC, Patel N, Kaushal R, Skibinski K, Brown RL, Karsh B-T (2012) Self-reported violations during medication administration in two paediatric hospitals. BMJ Qual Saf 21(5):408–415

    Article  Google Scholar 

  • Amalberti R, Vincent C, Auroy Y, de Saint Maurice G (2006) Violations and migrations in health care: a framework for understanding and management. Qual Saf Health Care 15(Suppl i):66–71

    Article  Google Scholar 

  • Armitage CJ (2008) A volitional help sheet to encourage smoking cessation: a randomized exploratory trial. Health Psychol 27(5):557–566

    Article  Google Scholar 

  • Battmann W, Klumb P (1993) Behavioural economics and compliance with safety regulations. Saf Sci 16(1):35–46

    Article  Google Scholar 

  • Beach LR (1990) Image theory: decision making in personal and organizational contexts. Wiley, Chichester

    Google Scholar 

  • Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  • Cook RI, Woods DD (2005) Operating at the sharp end: the complexity of human error. In: Bogner MS (ed) Human error in medicine. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  • Crosskerry P (2009) Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv Health Sci Educ 14:27–35

    Article  Google Scholar 

  • Dekker S (2003) Failure to adapt or adaptations that fail: contrasting models on procedures and safety. Appl Ergon 34:233–238

    Article  Google Scholar 

  • Dekker S, Bergström J, Amer-Wåhlin I, Cilliers P (2013) Complicated, complex and compliant: best practice in obstetrics. Cogn Technol Work 15(2):189–195

    Article  Google Scholar 

  • Dierks MM, Christian CK, Roth EM, Sheridan TB (2004) Healthcare safety: the impact of disabling “safety” protocols. IEEE Trans Syst Man Cybern A 34(6):693–698

    Article  Google Scholar 

  • Eccles MP, Johnston M, Hrisos S, Francis J, Grimshaw J, Steen N, Kaner EF (2007) Translating clinicians’ beliefs into implementation interventions (TRACII): a protocol for an intervention modelling experiment to change clinicians’ intentions to implement evidence-based practice. Implement Sci 2:27

    Article  Google Scholar 

  • Elliott MA, Armitage CJ (2006) Effects of implementation intentions on the self-reported frequency of drivers’ compliance with speed limits. J Exp Psychol Appl 12(2):108–117

    Article  Google Scholar 

  • English D, Branaghan RJ (2012) An empirically derived taxonomy of pilot violation behaviour. Saf Sci 50(2):199–209

    Article  Google Scholar 

  • Falzer PR (2004) Cognitive schema and naturalistic decision making in evidence-based practices. J Biomed Inform 37(2):86–98

    Article  Google Scholar 

  • Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R (2004) Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Technol Work 6(3):165–171

    Article  Google Scholar 

  • Gaba DM (1994) Human error in dynamic medical domains. In: Bogner MS (ed) Human error in medicine. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  • Gollwitzer PM, Sheeran P (2006) Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Soc Psychol 38:69–119

    Article  Google Scholar 

  • Grote G, Weichbrodt JC, Günter H, Zala-Mezö E, Künzle B (2009) Coordination in high-risk organizations: the need for flexible routines. Cogn Technol Work 11(1):17–27

    Article  Google Scholar 

  • Hale AR, Swuste P (1998) Safety rules: procedural freedom or action constraint? Saf Sci 29(3):163–177

    Article  Google Scholar 

  • Hayes J (2013) Operational decision-making in high-hazard organizations. Ashgate, Farnham

    Google Scholar 

  • Kahol K, Vankipuram M, Patel VL, Smith ML (2011) Deviations from protocol in a complex trauma environment: errors or innovations? J Biomed Inform 44:425–431

    Article  Google Scholar 

  • Klein GA (1993) A recognition-primed decision model of rapid decision making. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE (eds) Decision making in action. Ablex, Norwood

    Google Scholar 

  • Klein GA, Orasanu J, Calderwood R, Zsambok CE (1993) Decision making in action. Ablex, Norwood

    Google Scholar 

  • Lawton R (1998) Not working to rule: understanding procedural violations at work. Saf Sci 28(2):77–95

    Article  MathSciNet  Google Scholar 

  • Michinov E, Olivier-Chiron E, Rusch E, Chiron B (2008) Influence of transactive memory on perceived performance, job satisfaction and identification in anaesthesia teams. Br J Anaesth 100(3):327–332

    Article  Google Scholar 

  • Nemeth CP, Cook RI, Woods DD (2004) The messy details: insights from the study of technical work in healthcare. IEEE Trans Syst Man Cybern A 34(6):689–692

    Article  Google Scholar 

  • Nyssen A-S, Cote V (2010) Motivational mechanisms at the origin of control task violations: an analytical case study in the pharmaceutical industry. Ergonomics 53(9):1076–1084

    Article  Google Scholar 

  • Orasanu J, Connolly T (1993) The reinvention of decision making. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE (eds) Decision making in action. Ablex, Norwood

    Google Scholar 

  • Ouellette JA, Wood W (1998) Habit and intention in everyday life: the multiple processes by which past behavior predicts future behavior. Psychol Bull 124(1):54–74

    Article  Google Scholar 

  • Painter T, Ludbrook GL (2013) Reducing errors in the preoperative assessment process. Br J Anaesth 110(6):1060–1061

    Article  Google Scholar 

  • Paris H, Van Den Broucke S (2008) Measuring cognitive determinants of speeding: an application of the theory of planned behaviour. Transp Res Part F 11(3):168–180

    Article  Google Scholar 

  • Patel VL, Kaufman DR, Arocha JF (2002) Emerging paradigms of cognition in decision-making. J Biomed Inform 35(1):52–75

    Article  Google Scholar 

  • Phipps DL, Parker D, Pals EJM, Meakin GH, Nsoedo C, Beatty PCW (2008) Identifying violation provoking factors in a healthcare setting. Ergonomics 51(11):1625–1642

    Article  Google Scholar 

  • Phipps DL, Parker D, Meakin GH, Beatty PCW (2010) Determinants of intention to deviate from clinical guidelines. Ergonomics 53(3):393–403

    Article  Google Scholar 

  • Reason J, Manstead A, Stradling S, Baxter J, Campbell K (1990) Errors and violations on the road: a real distinction? Ergonomics 33(10–11):1315–1332

    Article  Google Scholar 

  • Reason J, Parker D, Lawton R (1998) Organizational controls and safety: the varieties of rule-related behaviour. J Occup Org Psychol 71(4):289–304

    Article  Google Scholar 

  • Suchman L (1987) Plans and situated actions: the problem of human–machine communication. Cambridge University Press, Cambridge

    Google Scholar 

  • Verplanken B (2006) Beyond frequency: habit as mental construct. Br J Soc Psychol 45(3):639–656

    Article  Google Scholar 

  • Wiggins MW, Hunter DR, O’Hare D, Martinussen M (2012) Characteristics of pilots who report deliberate versus inadvertent visual flight into instrument meteorological conditions. Saf Sci 50(3):472–477

    Article  Google Scholar 

  • Woods DD, Shattuck LG (2000) Distant supervision–local action given the potential for surprise. Cogn Technol Work 2:242–245

    Article  Google Scholar 

  • Woods DD, Johannesen LJ, Cook RI, Sarter NB (1994). Behind human error: cognitive systems, computers, and hindsight. CSERIAC report SOAR 94-01. Defense Technical information Center, Alexandria, VA

  • Woods DD, Patterson ES, Cook RI (2007) Behind human error: taming complexity to improve patient safety. In: Carayon P (ed) Handbook of human factors and ergonomics in health care and patient safety. Lawrence Erlbaum Associates, Mahwah

    Google Scholar 

  • Xiao Y, Seagull FJ, Nieves-Khouw F, Barczak N, Perkins S (2004) Organizational-historical analysis of the “failure to respond to alarm” problems. IEEE Trans Syst Man Cybern A 34(6):772–778

    Article  Google Scholar 

  • Zajac S, Gregory ME, Bedwell WL, Kramer WS, Salas E (2013) The cognitive underpinnings of adaptive team performance in ill-defined task situations: a closer look at team cognition. Org Psychol Rev. doi:10.1177/2041386613492787

    Google Scholar 

  • Zala-Mezö E, Wacker J, Künzle B, Brüesch M, Grote G (2009) The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. Qual Saf Health Care 18(2):127–130

    Article  Google Scholar 

Download references

Acknowledgments

This study was funded by the Engineering and Physical Sciences Research Council (EP/C513339/1). The authors would like to thank Paul Beatty, George Meakin, Chidozie Nsoedo, and Elisah Pals for their assistance with the work.

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Authors and Affiliations

  1. NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom

    Denham L. Phipps & Dianne Parker

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  1. Denham L. Phipps
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  2. Dianne Parker
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Correspondence to Denham L. Phipps.

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Phipps, D.L., Parker, D. A naturalistic decision-making perspective on anaesthetists’ rule-related behaviour. Cogn Tech Work 16, 519–529 (2014). https://doi.org/10.1007/s10111-014-0282-2

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  • DOI: https://doi.org/10.1007/s10111-014-0282-2

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