Biomedical Engineering Reference
In-Depth Information
does not systematically lead to identical strategies for action. In other
words, regulated safety does not 'crush', in this case, the situated deci-
sions made by the subjects, and it always requires managed safety as a
complement. For instance, in oncology, therapeutic benchmarks contain
a number of decision criteria whose values are adapted when they are
combined with the specific characteristics of the patients to be treated. In
particular, the patient's age is expressed in chronological terms, whereas
doctors reason from the patient's physiological age, and may then end up
tailoring the treatment that is recommended by the benchmark.
Whereas in the normative approach, this variability of possible solu-
tions might be seen as regretful, the adaptive approach views, instead, rules
as resources that support and provide input for managed safety, without
substituting themselves for managed safety. In this case, regulated safety
and managed safety constantly combine with one another, and both of
them are necessary to achieve overall safety. Indeed, it can be noted that
this variability of work practices does not make it impossible to reach a
high level of overall safety. On the contrary, various works have shown
that the diversity of strategies allowed by the rules can, in some conditions,
prove to be a margin of adaptation that is profitable for the development of
safety (Amalberti, 1992; Cuvelier et al., 2012). Returning once again to our
example, anaesthetic medicine is an 'ultrasafe' system that is viewed as
pioneering the field of healthcare safety (Amalberti et al., 2005). Analyzing
the activity of anaesthetists shows that choosing a strategy from the set of
'possible strategies' results from a subtle trade-off, allowing each worker
to find the most appropriate balance between the singular features of the
case being treated, on the one hand (the patient, the patient's decisions,
the family, the complexity of pathologies, organizational constraints, etc.),
and the resources that are available to deal with this case, on the other
hand (the doctor's own skill set, the skills of the medical team, the mas-
tery of equipment and medical techniques, the development of rules of
the trade, etc.). It is this process of matching the features of the case with
the available resources, a process that is always singular, that allows each
doctor and each medical team to work within their respective fields of
expertise, and therefore to reach a very high level of safety - regardless
of the difficulty, the rarity or the unpredictability of a particular case.
Rules may not cover some of the cases
Some fields of human activity are less prescriptive than others, in terms
of well-described work procedures. In these situations where there is
no external rule, the standard, the reference can be a priori internal to
an individual worker or to a trade. Hence, the activity of workers will
essentially depend on their ability to 'invent' new rules. Yet, when the
characteristics of a given situation question the applicability of prescribed
