Utilising organisational mindful routines to mitigate patient risks during a crisis: a view from within

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Flynn, Ger
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University College Cork
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Modern healthcare is complex, encompassing numerous interconnecting elements such as people, technology, data and organisational routines to safeguard patient safety and maintain public confidence. Crises are disruptive phenomena that present a restricted amount of time to respond, testing the reliability and appropriateness of these interconnecting elements to their extreme. Organisational Mindfulness (OM), is accredited for developing awareness in volatile, uncertain, and complex circumstances such as healthcare delivery and its application is promoted as a method of achieving high reliability (Weick et al., 2008; Davidson and Begley, 2012; Bennett and Lemoine, 2014; Svalgaard, 2018). Positioned at the intersection of crisis management and resilience, this study links crises, OM, organisational routines, and the role of data for pre-empting and containing crises situations. Organisational routines are conceptualised as sources of stability. However, when organisations are suddenly faced with a crisis, organisational routines that contain mindless elements may weaken the organisations resilience diminishing the reliability of the response to the disruption. Where an organisations’s core function is healthcare then unreliable responses to a crisis can be detrimental to the safety of the patient. This study explores the multimodality of processes by which organisations respond and adapt to a catastrophic event including improvising. Positioned within the genre of personally relevant research, the core motivation of the thesis is driven by a desire of the author (the National Clinical Head of Medical Devices - HSE) to enhance organisational resilience to mitigate the risk to the patient. The methodologies of ‘inquiry from the inside' (Paper One and Paper Three) and Analytic Autoethnographic (Paper Two) are used to contextualise crises, providing rich insight to the disruption caused from living the experience. 'The outcome of this research provides a deep understanding of all the contrasting crises that threatened the safety of the patient. The thesis contributes eight OM routines with mindful data as the foremost novel contributions. Paper One highlights where a crisis was triggered by hidden endogenous elements that culminated in a mindless decision to replace ultrasound scanners. The study offers a routine practice contribution by highlighting the dangers and benefits of the mindless routine, ‘Learned Helplessness’. ‘Learned Helplessness’ routine uncovered through OM analysis had devastating effects on patient safety but paradoxically also allowed the organisation to function during the crisis. In addition, the study reveals the 'Technology Scapegoating' routine, which highlights the dangers of impulsiveness to place technology as the source of error, rather than people. Paper Two illustrates where the characteristics of the first wave of the COVID-19 crisis suddenly made an organisational process inappropriate, generating unprecedented disruptions that posed an extreme risk to patient safety. The concept of the ‘Pursuit of Certainty’ routine is offered as a mindful routine contribution suggesting that process deviations guided by OM during crises can improve the reliability of the organisation achieving its objective. Paper Three contributes mindful data where a resilient data supply chain focused appropriate actions necessary to manage the essential elements within the critical care environment during the third wave of COVID-19. The concept of ‘mindful data’ ensures the right data is captured from the right people, and in an accurate fashion, reducing the risk of errors or failures in its provision and use. The outcome of the study on crises highlights the devastating effects on patient safety that mindless routines can have if not uncovered within an organisation. Motivated by a desire to enhance organisational resilience to mitigate patient risks during crises, this study contributes eight OM routines to achieve this objective. This study on crises highlights the reliable agility offered by mindful routines and the benefit of purposeful mindful data for coping with the many adverse evolving challenges that sudden crises present.
Organisational mindfulness , Crisis , Routines , Analytic autoethnography
Flynn, G. 2022. Utilising organisational mindful routines to mitigate patient risks during a crisis: a view from within. PhD Thesis, University College Cork.
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