RESUMO
BACKGROUND: Although slack is an asset to resilient hospitals, it is usually explicitly discussed only in terms of the quantity and quality of beds and staff. This paper expands this view by addressing slack in four infrastructures of intensive care units (ICUs) (physical space, electricity supply, oxygen supply, and air treatment) during the COVID pandemic. METHODS: The study occurred in a leading private hospital in Brazil, aiming at the identification of slack in four units originally designed as ICUs and two units adapted as ICUs. Data collection was based on 12 interviews with healthcare professionals, documents, and comparison between infrastructures and regulatory requirements. RESULTS: Twenty-seven instantiations of slack were identified, with several indications that the adapted ICUs did not provide infrastructure conditions as good as the designed ones. Findings gave rise to five propositions addressing: relationships intra and inter infrastructures; the need for adapted ICUs that match as closely as possible the designed ICUs; the consideration of both clinical and engineering perspectives in design; and the need for the revision of some requirements of the Brazilian regulations. CONCLUSIONS: Results are relevant to both the designers of the infrastructures and to the designers of clinical activities as these must take place in fit-for-purpose workspaces. Top management might also benefit as they are the ultimate responsible for decision-making on whether or not to invest in slack. The pandemic dramatically demonstrated the value of investing in slack resources, creating momentum for this discussion in health services.
Assuntos
COVID-19 , Pandemias , Humanos , COVID-19/epidemiologia , Unidades de Terapia Intensiva , Pessoal de Saúde , Coleta de DadosRESUMO
BACKGROUND: Disasters are the result of adverse events that cause human, material, environmental, and economic and social damage. To deal with disaster management, prevention, response, and recovery organizations need a system of indicators to measure their resilience. OBJECTIVE: To develop a road map to select indicators of organizational, institutional and governmental resilience to be applied to evaluate the resilience of public Protection and Civil Defense Organizations (PCDOs) of developing countries. METHOD: A literature review on resilience indicators for disaster management using Scopus database, identifying and classifying the resilience indicators available in the scientific literature, to discuss the possibilities of their application in PCDOs. RESULTS: Resilience indicators for disaster management available in the literature have many diverse classifications and they were developed for the evaluation of communities' resilience. The literature review results also indicated that there is a lack of indicators to evaluate PCDOs' resilience. CONCLUSIONS: Indicators of the institutional, organizational and governmental categories identified in the review, originally developed for the evaluation of communities' resilience, can be used to compose a hybrid system of resilience indicators able to measure the resilience of PCDOs.
Assuntos
Defesa Civil , Planejamento em Desastres , Desastres , Humanos , OrganizaçõesRESUMO
Although complexity and resilience are key inter-related characteristics of construction projects, little is known on how to monitor these characteristics and their implications for safety management. This study investigates the contribution of Safety Performance Measurement Systems (SPMS) as a means for monitoring and understanding of sources of complexity and resilience in construction. It is based in three empirical studies carried out in construction projects, two in Chile and one in Brazil. Two main tools were applied in these studies: (i) the Technical, Organizational and Environmental (TOE) framework, focused on complexity; and (ii) the Resilience Assessment Grid (RAG), focused on resilience. Improvement opportunities were identified for existing SPMS. Also, a set of guidelines for the design of SPMS emerged from these studies as well as a model that explains the connections between the main constructs encompassed by the guidelines.
Assuntos
Prevenção de Acidentes/métodos , Acidentes de Trabalho/prevenção & controle , Indústria da Construção , Gestão da Segurança/métodos , Brasil , Chile , Guias como Assunto , HumanosRESUMO
Emergency response organizations need to be resilient to cope with escalating events resulting from dynamic, unexpected, or complex situations. In Brazil, the Firefighter Corps are military hierarchal organizations with a culture based on fixed structures, well defined norms and procedures. These push against innovations which are necessary to be resilient. This research describes how firefighter captains in the 30-35-year age range managed an emergency response escalation in light of standard operating procedures (SOPs) during a training exercise. The study used ethnographic methods to find and discuss gaps between the instructions and the activities carried out during the exercise, highlighting the differences between work as done (WAD) and work as imagined (WAI), as it was instantiated in the SOP prescriptions. The aim was to produce reflections on WAI and WAD as a way to raise awareness of the need for a cultural change toward resilience in firefighter organizations. This was achieved through firefighter engagement with a comprehensive visualization of the analysis results which afforded easy interaction between the experts, the data, and the researchers.
Assuntos
Bombeiros/psicologia , Trabalho/psicologia , Adulto , Antropologia Cultural , Brasil , Humanos , Imaginação , Masculino , Resiliência PsicológicaRESUMO
Although the use of resilience skills (RSs) by emergency department (ED) front-line staff is ubiquitous, the nature and origin of these skills tend to be taken for granted. This study investigates the research question "where do RSs come from"? Case studies in two EDs were undertaken in order to answer the research question: one in Brazil and the other in the United States. The case studies adopted the same data collection and analysis procedures, involving interviews, questionnaires, observations, and analysis of documents. A model for describing RSs as emergent phenomena is proposed. The model indicates that RSs arise from interactions between: work constraints, hidden curriculum, gaps in standardized operating procedures, organizational support for resilience, and RSs themselves. An instantiation of the model is illustrated by a critical event identified from the American ED. The model allows the identification of leverage points for influencing the development of RSs, instead of leaving their evolution purely to chance.