Enabling success in dynamic environments: incremental safety practices in the emergency CT pathway

Motivation: one of the perceived “causes” of preventable patient mortality are inefficiencies and delays in the emergency CT pathway. Decremental safety approaches struggle to put successful protective barriers in place. Method: we reconceptualise delays as an outcome of context-conditioned variability and interconnections between different functions of the work system with the aim to strengthen the system’s ability to manage variability and adapt to changing circumstances, i.e., to function successfully more often. Results: Several improvement ideas were identified. One of these related to a review of portering arrangements between the ED and the radiology department. This change was implemented as a trial in June 2024 and will run until August 2024. Data were collected both quantitatively (time related metrics) as well as qualitatively (staff perceptions about how the intervention brings about change and under what circumstances). Goal attainment: an overarching ambition was to improve the collaboration, coordination and shared learning between ED and radiology to help them work more successfully in the future. A separate and more rigorous evaluation is needed to assess the longer-term impact.