Biomedical Engineering Reference
In-Depth Information
Applying the rule is viewed as counterproductive
However, in this same example, recovery may prove to be impossible
because of the poor availability of doctors. X-ray operators must then per-
form a trade-off between treating and not treating a patient for whom the
medical validation that is required by regulations has not been provided:
to carry out the treatment and violate the procedure or to cancel the ses-
sion and comply with the rule. The strategies of the x-ray operators are
based upon a cost-benefit analysis of whether to violate or comply with
the rule. This may lead them to make a reasoned trade-off and to apply
the rule (and not carry out the treatment) or to violate it (carrying out the
treatment without validation). Risks are present regardless of the decision
made. In the first case, the patient will not receive the daily dose of treat-
ment, and his or her chances of survival may be reduced. In the second
case, going ahead with the session with a nonvalidated patient file leads
to a risk of the treatment not being in accordance with regulations - which
operators view as a less serious risk than the patient failing to receive the
daily dose.
A second example is derived from the field of air transportation
(Dicioccio, 2012). This field is a second reference to ultrasafe systems: all
of the stakeholders involved must comply with an impressive number of
safety rules and procedures. In this hyperprocedural system, particularly
in aircraft maintenance, the adaptations that are made by sharp-end oper-
ators to cope with unforeseen events may lead to a failure to comply with
rules to 'achieve expected performance' (Amalberti, 2007). At this point,
managed safety steps in to make a trade-off between making use and not
making use of existing rules, in order to preserve performance with an
acceptable level of safety. When faced with an overabundance of rules and
procedures, the technicians must adapt to the variations related to con-
textual factors and to the related constraints. Because of this, trade-offs
are an expression of a reasoned adaptation of procedures by the workers
(Amalberti, 2007). For example, in the event of identifying a defect in an
aircraft that is set to take off, the technicians assess the severity of the
defect and its possible evolutions, by carrying out a technical analysis of
the defective equipment or associated systems, and of its impact on the
running of the aircraft. Therefore, the risk taken in the trade-off - to allow
or fail to allow the plane to take off - is minimized. The adaptation pro-
duced by the more experienced technicians manifests itself in the form
of strategies of anticipation, supervision and implementation of means to
reassess the situation. In this way, managed safety allows the technicians
not just to decide what degree of transgression of the rules that they deem
acceptable, but also to construct a strategy of action that is acceptable in
terms of safety and performance.
