Healthcare in hospitals grows increasingly complex due to the involvement of multiple professionals per patient and the rapid evolution of knowledge and technology. This demands continuous collaboration and reinterpretation of quality of care to maintain consistent outcomes, yet many professionals find this time-consuming.
In part I —two ethnographic investigations in operating teams—we explored time pressure and its role in quality improvement. Time pressure was linked to conflicting team goals. Shared situational awareness helped address these conflicts, improve care quality, and manage time pressure more effectively. Routines appeared insensitive to time pressure.
In part II —two action research projects on a paediatric ward—we examined whether daily quality improvement without time pressure was possible by fostering shared awareness, resolving goal conflicts, and shaping routines. The descriptions provide a practical illustration and enhancement of...
Show moreHealthcare in hospitals grows increasingly complex due to the involvement of multiple professionals per patient and the rapid evolution of knowledge and technology. This demands continuous collaboration and reinterpretation of quality of care to maintain consistent outcomes, yet many professionals find this time-consuming.
In part I —two ethnographic investigations in operating teams—we explored time pressure and its role in quality improvement. Time pressure was linked to conflicting team goals. Shared situational awareness helped address these conflicts, improve care quality, and manage time pressure more effectively. Routines appeared insensitive to time pressure.
In part II —two action research projects on a paediatric ward—we examined whether daily quality improvement without time pressure was possible by fostering shared awareness, resolving goal conflicts, and shaping routines. The descriptions provide a practical illustration and enhancement of Safety II principles. Using complexity theory, we reflected on the role of the participatory action researcher who facilitated interactions among parents, nurses, and physicians.
Our conclusion: incremental, daily learning and improving without time pressure is achievable when integrated into existing routines. However, transformative learning requires stakeholders to endure periods of uncertainty and apparent stagnation, during which time pressure is felt, and an external perspective can be valuable.
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