Figure legends.
Figure1 : The varieties of human work. Conceptualising human work is important when considering how outcomes are achieved and what impacts the success and/or safety of the task in hand. Shorrock has described four basic varieties of human work. Work as done is, simply put, what actually happens in the workplace and is best analysed by direct observation; work as imagined is how people think work is done at the frontline and is influenced by various factors including past experience, knowledge of the work that is being undertaken and personal bias; work as disclosed is what people say or write about their work and work as prescribed is the formal description (usually written e.g. as an SOP) of how work should be done. The figure depicts the four basic varieties of human work (described by Shorrock) revealing areas of overlap and of difference for each type.
Figure 2: The Systems Engineering Initiative for Patient Safety – SEIPS. SEIPS was designed by systems engineers and human factors scientists in collaboration with healthcare providers to be a framework for analysing healthcare systems, examining work processes and designing interventions to improve patient safety.
The figure provides an overview of the model with patient at the centre of the healthcare system described within socio-organisational contexts. Key factors influencing patient safety are divided into people (e.g. clinical teams, family members or the patient themselves), environments (e.g. physical, cultural), tasks (which may involve multiple interdependent teams) and tools and technologies, all of which are influenced in turn by external environmental factors (e.g. regulatory bodies or government policy). The SEIPS model recognises the adaptive nature of healthcare systems with a feedback loop from outcomes back into the work system. SEIPS 101 describes a series of simplified ways of using SEIPS to analyse work in healthcare. The PETT (People, Environments, Task, Tools and technology) scan is one example which can be used in many contexts to consider facilitators and barriers to safe practice (e.g. to examine tasks involved in a ward round or to analyse a safety incident and consider contributory factors). It was chosen for this study as it was designed to be straightforward to use in any clinical context.