HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cook, R Articles by Rasmussen, J Search for Related Content PubMed PubMed Citation Articles by Cook, R Articles by Rasmussen, J

"Going solid": a model of system dynamics and consequences for patient safety

¹ Department of Anesthesia and Critical Care, University of Chicago, Chicago, USA
² Smorum Bygade 52, DK 2765, Denmark

Correspondence to:
Dr R I Cook
5841 S Maryland Ave, MC4028, Chicago, IL 60615, USA; ri-cook{at}uchicago.edu
ABSTRACT
Rather than being a static property of hospitals and other healthcare facilities, safety is dynamic and often on short time scales. In the past most healthcare delivery systems were loosely coupled—that is, activities and conditions in one part of the system had only limited effect on those elsewhere. Loose coupling allowed the system to buffer many conditions such as short term surges in demand. Modern management techniques and information systems have allowed facilities to reduce inefficiencies in operation. One side effect is the loss of buffers that previously accommodated demand surges. As a result, situations occur in which activities in one area of the hospital become critically dependent on seemingly insignificant events in seemingly distant areas. This tight coupling condition is called "going solid". Rasmussen’s dynamic model of risk and safety can be used to formulate a model of patient safety dynamics that includes "going solid" and its consequences. Because the model addresses the dynamic aspects of safety, it is particularly suited to understanding current conditions in modern healthcare delivery and the way these conditions may lead to accidents.

Keywords: patient safety; system dynamics; "going solid"; accidents; margins

This article has been cited by other articles:

				A. T. Pedroja The Tipping Point: The Relationship Between Volume and Patient Harm American Journal of Medical Quality, September 1, 2008; 23(5): 336 - 341. [Abstract] [PDF]

				R. Koppel, T. Wetterneck, J. L. Telles, and B.-T. Karsh Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 408 - 423. [Abstract] [Full Text] [PDF]

				P. M. Sanderson, M. O. Watson, W. J. Russell, S. Jenkins, D. Liu, N. Green, K. Llewelyn, P. Cole, V. Shek, and S. S. Krupenia Advanced Auditory Displays and Head-Mounted Displays: Advantages and Disadvantages for Monitoring by the Distracted Anesthesiologist Anesth. Analg., June 1, 2008; 106(6): 1787 - 1797. [Abstract] [Full Text] [PDF]

				R L Wears Keep the celebrations short Qual. Saf. Health Care, June 1, 2005; 14(3): 154 - 154. [Full Text] [PDF]