Risk management from incident reporting to criticalities detection: a methodological proposal. A case study.

Incident reporting in the Health Care could be underused or misused because of a cultural and organizational context characterised by the so called blame culture, whose effects are that workers perceive it as a control tool used by the management to find guilty operators. We believe that incident reporting is not effective for safety if it is not supported in advance by other tools that focus on weak signals and treat anomalies and human error as a resource for organizational learning and not something to hide and blame (Weick and Sutcliffe, 2007). This frame was the ground for a project realised in the Italian health care domain, whose aim was to increase the commitment of operators and managers towards an organisational culture oriented to safety and well-being, of both the operators and the patients. The project involved 60 operators (nurses and physicians) from six hospitals, during 2010 and 2011. Using the action research methodology, the participants analysed their own activities and developed a tool for the detection of organisational criticalities within the SHELL model frame (Hawkins, 1975). Each participant has been supported in order to involve the hospital workers in the implementation of the tool. The tool has been developed starting from activities, and it is aimed at providing outcomes at the operational level. It is composed by three steps that allow: 1) to detect and monitor problems concerning well-being and safety. It allows operators to signal problems, their frequency, and take into account the factors that produce them and the potential consequences; 2) to propose a solution for those problems in order to give a personal contribution to the increase of the general safety and well-being. This enhances an internal locus of control and assumption of responsibility in process management; 3) to involve operators in process monitoring and tracking the steps towards a solution, assessing also the adequacy of intermediate outcomes and the possibility of further actions. This methodology had as positive outcomes: the reduction of the learned helplessness and resignation, the enhancement of an internal locus of control, the development of a traceable process monitoring that unifies the problem diagnosis phase and the solution implementation assessment, and the possibility to be used for evaluating work related stress.