ICUs are complex adaptive systems, a land of the unexpected. They manage high-risk patients. Due to the high costs involved, resources do not account for operational workload peaks and the complexity of extreme clinical conditions. Consequently, staff frequently face overload episodes that exceed the unit’s operational capacity. Care processes are also subjected to numerous unpredictable events due to the random occurrence of various pathologies, significant uncertainties regarding the evolution of patients’ conditions, and limitations of medical knowledge in the face of the complexity of some pathologies. Hence, many of the care processes are under-specified and staff are regularly pushing their boundaries. As such, ICUs provide particularly good illustrations of the notion of resilience, and resilience engineering.
To discuss how to overcome everyday disturbance inspired by success story of ICU resilience.
The workshop will present the case of a particular ICU in which, in addition to the generic difficulties mentioned above, a poorly managed merger of two hitherto separate services triggered an organisational crisis. Despite this crisis, the overall performance of the service significantly increased. More patients were admitted, peak hours were better-handled, re-admission rates decreased, the efficiency and the quality of care improved. The workshop will present an interpretation of this success story inspired by resilience engineering, and invite the participants to discuss the main points that could be taken away to help other organisations to overcome everyday, as well as more profound, disturbances.
Jean Pariès, President Dedales