Friday, 22 August 2014

The ice bucket challenge and other buckets

Bill Gates has a fancy ice bucket
This time next year no one will remember what the ice bucket challenge was about, so a brief description is called for:

In the summer of 2014 people in the United States started pouring ice water over their heads in support of the Amyotrophic Lateral Sclerosis (ALS) Association. Spread via social media the challenge was adopted by the Motor Neurone Disease Association in the UK and then Macmillan Cancer Support. Various versions exist, one of the more popular is to have to donate a small amount of money if accepting the challenge and a larger amount if not willing to be drenched in ice-cold water. (Billionaires tend to accept the challenge).

The tenuous link to simulation and human factors is that buckets are also found in our areas of interest…

The s**t buckets (James Reason's three bucket model)

James Reason asks us to consider three buckets, each bucket has things that will fill it up:
  1. Self
    1. Knowledge
    2. Skill
    3. Expertise
    4. Current capacity (stressed, tired, ill…)
  2. Context
    1. Equipment and devices (poorly maintained, broken, poorly designed…)
    2. Physical environment (too hot, noisy, unlit…)
    3. Workspace (novel, poorly laid out, interruptions…)
    4. Team and support (unfamiliar, poorly led, unclear roles…)
    5. Organisation and management (poor safety culture, steep authority gradient…)
  3. Task
    1. Errors (omission, commission, fixation…)
    2. Complexity
    3. Novelty
    4. Process (overlaps, multi-tasking…)
The more full the buckets are, the greater the risk of poor performance/error. Reason suggests that the more full the buckets are the more attention we need to focus on the task and, at a certain fill level, not start the task.

The mental workload bucket

This bucket was referred to in a previous blogpost. The workload bucket fills up as the number of tasks increase. The capacity and volume that a given task occupies are also affected by stress and expertise. When the workload bucket is full, it overflows and "something" has to make way for the new task.

The IV fluids bucket

The last bucket is for the simtechs. The IV fluids bucket sits under the bed/trolley/gurney and collects the fluids and drugs that participants on a sim course give the mannequin. This means that instead of pretending to give 6 litres of 0.9% NaCl, the participants can really give it and watch for hyperchloraemic acidosis...

Further reading

Reason J (2004) Beyond the organisational accident: the need for ‘error wisdom’ on the frontline. Quality and Safety in Health Care. 13, (Suppl 2), ii28–ii33.

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