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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.

Bruno, A., Bracco, F., & Sossai, D. (2012). Risk management from incident reporting to criticalities detection: a methodological proposal. A case study. 10th EAOHP Conference, Zurich 11th-13th April. PDF

Favorire il cambiamento nelle organizzazioni: una rivoluzione silenziosa

La psicologia del lavoro si sta progressivamente spostando da una visione reificata dell’organizzazione, come una entità separata dalle persone, a una visione dinamica, dove la differenza tra livello individuale e livello organizzativo si fa più sfumata: non esiste l’organizzazione ma l’organizzare, ossia l’azione complessa e sinergica di persone, regole e ambienti. Questo cambiamento di prospettiva permette di ripensare gli interventi sulla promozione della salute, della sicurezza e del benessere. Finora, uno dei limiti della visione dualista del sistema (persona versus organizzazione) era dovuto al fatto che spesso le ragioni del malessere delle persone erano riconducibili all’organizzazione e quindi si finiva con il ritenere che il problema provenisse da quell’altrove non meglio specificato. Ciò portava solo all’aumento del malessere, del cinismo organizzativo e dell’impotenza appresa, perché l’organizzazione finiva per essere un comodo fantasma su cui scaricare responsabilità. Ma in quanto fantasma, l’organizzazione era un’entità da cui ci si attendeva invano un cambiamento, quando invece il cambiamento proviene dalle persone e solo da loro. La prospettiva unitaria e complessa, di persone che organizzano, porta a dare potere di azione agli individui e ai gruppi, a renderli consapevoli delle dinamiche, delle procedure e delle prassi. Proprio in questa nuova prospettiva, riportiamo esperienze in cui abbiamo cercato di sfatare questo fantasma dell’organizzazione, portando l’approccio rogersiano nel modo di stare con le persone e nel modo di costruire relazioni più efficaci e autentiche sui luoghi di lavoro. L’Approccio Centrato sulla Persona, per definizione, sposta l’accento dall’organizzazione alle persone, ognuno si sente ascoltato e impara ad ascoltarsi, ad ascoltare. È un cambiamento scomodo, lungo e silenzioso. È un cambiamento che porta al potere personale di ognuno di fare qualcosa per il benessere e la salute propria e degli altri.

Bracco, F., & Belgrano, G. (2012). Favorire il cambiamento nelle organizzazioni: una rivoluzione silenziosa. Presentazione al Congresso Nazionale dell’Istituto dell’Approccio Centrato sulla Persona, Messina, 15-17 giugno 2012. PDF

User-centered evaluation of the Virtual Binocular Interface

Abstract: This paper describes a full-body pointing interface based on the mimicking of the use of binoculars, the Virtual Binocular Interface. This interface is a component of the interactive installation “Viaggiatori di Sguardo”, located at Palazzo Ducale, Genova, Italy, and visited by more than 5,000 visitors so far. This paper focuses on the evaluation of such an interface.

Glowinski, D., Mancini, M., Coletta, P., Ghisio, S., Chiorri, C., Camurri, A., & Volpe, G. (2011). User-centered evaluation of the Virtual  Binocular Interface. Paper presented at the International Conference on INtelligent TEchnologies for interactive enterTAINment,  Genova (Italy), 25-27 May. PDF

Risk perception in the health care domain, between clinical risk and practitioners safety: a study among operating theatres practitioners
Objectives: Risk perception among operating theatres’ practitioners is investigated concerning both the relationship between personal safety and patients’ safety and the perception of causes of accidents.
Methods: A quantitative checklist of Incident Reporting has been used. It consisted in 13 items about clinical risks and 8 items about practitioners’ risks, considering injury frequency and seriousness, its causes and near misses. Participants were 139 and were recruited among physicians, surgeons, anesthetists, nurses of 14 operating theaters of a north Italian wide hospital.
Results: Spearman’s Rho index reveals mild positive correlations between injuries to operators and injures to patients concerning frequency (means = 0,10) and gravity (means = 0,22). The same trend is found for near misses involving operators and patients (r = 0,26); the perception of the frequency and severity of injuries (means = 0,54), and the frequency of accidents and near misses (means = 0,66). We notice also that injuries are positively associated with communication problems and the lack of personal protection devices. The personal and professional characteristics have a positive correlation with accident frequency in case of missed control of devices (correlation with age: r = 0,29; with job experience: r = 0,24). Age and expertise negatively correlate with the frequency of accidents in case of patient injury due to devices failures (r = 0,30 and 0,27 respectively).
Implications: Frequency and seriousness of the practitioners’ and the patients’ risks are positively correlated, and this relationship strengthens when also considering near misses. Communication problems and the absence of devices for personal protection seem to be the most probable causes of accidents, the first if injuries are very frequent, the second if injuries are serious. Professional experience seems to be linked with perceptions of accidents due to behavioural routines, while low surgical skills are correlated with perceptions of accidents due to lack of technical expertise or a scarce sensitivity to dangerous conditions.
Conclusions: These results suggest that the promotion of safety in operating theatres could concern both operators and patients, thanks to an organisational commitment investing in technical matters like personal protection devices to reduce the most frequent accidents (technical approach to safety), but to reducing severe accidents needs making actions at the level of staff management (social approach to safety), also considering age and expertise differences. This tool could be used as a link between organisational practices and the health and safety promotion culture.

Bruno, A., Bracco, F., Chiorri, C., Pugliese, F., Sossai, D., & Palombo, P. (2010). Risk perception in the health care domain, between  clinical risk and practitioners safety: a study among operating theatres practitioners. Talk given at the 9th Conference of the  European Academy of Occupational Health Psychology, Rome, 29-31 March.  PDF

An investigation of the minimal visual cues required to recognize emotions from human upper-body movements
Abstract: This paper illustrates a research project on the visual cues that
account for the ability to recognize emotions from upper-body movements. We describe an experiment that evaluated whether human observers could discriminate between high and low arousal emotions by means of impoverished displays representing the motion and shape information of the head and the hands. We investigated the effects of figure-ground segregation and inversion of the displays on (i) the recognition of emotion, (ii) the perception of biological motion and (iii) the animacy experience.

Glowinski, D., Camurri, A., Coletta, P., Bracco, F., Chiorri, C., Atkinson, A.P. (2008). An investigation of the minimal visual cues required to recognize emotions from human upper-body movements. Workshop on Affective Interaction in Natural Environments (AFFINE), Chania, October 24th. PDF

Rilevazione della situation-awareness nei controllori radar ed implicazioni per  l’addestramento

 Situation Awareness (SA) is a notion currently evoked to talk about the failure of human reliability in critical situations, which can lead to accidents. Whilst a plethora of data has been gathered on situation awareness, its theoretical status has been questioned for long: is it a psychological variable or rather simply a “label” to describe complex systems failures? In fact, SA has demonstrated to be a useful descriptive tool, but it may turn out to be misleading if not properly characterized. Simulation is a common practice in aviation for many reasons, but it is far from being completely granted: what do we mean by the term “simulation fidelity”? What epistemological and methodological difficulties may we expect when using simulation for research purposes? To what extent we may trust training simulation results in relation to the real operational world? In this talk we present a research carried out at ENAV Academyin Forlì, the training department of ENAV (Ente Nazionale Assistenza al Volo), the Italian Air Traffic Management organization. On that occasion, an Italian-language version of a set of tools recommended by EUROCONTROL, the European Air Traffic Control Authority was tested in two independent samples of air traffic controllers trainees and instructors. A relevant body of data was gathered and has been interpreted.

Pisano, L., Bracco, F., & Chiorri, C. (2008). Rilevazione della situation-awareness nei controllori radar ed implicazioni per  l’addestramento. Comunicazione al convegno Ergonomia e fattori umani: ricerche ed applicazioni di interesse navale, Genova 2 Aprile. PDF

Sistemi di misura del carico di lavoro

In questa ricerca si presenta La validazione del NASA-TLX, uno strumento di valutazione soggettiva del carico di lavoro mentale che si dimostra particolarmente utile per studi sui fattori umani nei settori dei trasporti, in particolare nelle ricerche sul carico di lavoro in campo marittimo, militare e aeronautico. Lo strumento presenta numerosi vantaggi, fra cui: semplicità di somministrazione, rapidità di somministrazione, bassi costi di realizzazione, bassa intrusività con il compito, attendibilità delle risposte.

Bracco, F., & Chiorri, C.  (2008). Sistemi di misura del carico di lavoro. Comunicazione al convegno Ergonomia e fattori umani: ricerche ed applicazioni di interesse navale. Genova, 2 aprile. PDF

Resilience engineering in Emergency Room operations: A theoretical framework

System resilience implies practitioners’ capacity to cope with unexpected events, i.e. cognitive resilience. To address it, we outline a framework based on the Skill-Rule-Knowledge model grounding it in the operators’ sensitivity to the variety that normally occurs in complex systems activities. This variety can contain hidden information enabling the organization to be proactive and to manage unexpected events. Each situation can be described with a SRK profile, according to the kind of cognitive processes necessary to control it. Operators’ reliability can therefore be analyzed by evaluating the match between their cognitive SRK profile and that demanded by the current situation. System resilience is ensured by the capacity of operators to: (i) choose the most suitable cognitive level; (ii) freely move along these levels according to the situation; (iii) be mindful towards variety; (iv) transfer their personal mindfulness into group dynamic adaptation. The outcome of these behaviors is a balance of mindfulness (constant attention to anomalous signals) and dynamic adaptation (organizational adjustment of existing rules according to the new information). This continuous equilibrium between chaos and order is the strategy followed by adaptive complex systems in order to evolve and can be successfully applied to high risk organizations to enhance the emergence of resilient behaviors.

Bracco, F., Gianatti, R., & Pisano, L. (2008). Resilience engineering in Emergency Room operations: A theoretical framework. Third Symposium in Resilience Engineering, Antibes, October 2008. Link

Technique for automatic emotion recognition by body gesture analysis

Abstract: This paper illustrates our recent work on the analysis of expressive gesture related to the motion of the upper body (the head and the hands) in the context of emotional portrayals performed by professional actors. An experiment is presented which is the result of a multidisciplinary joint work. The experiment aims at (i) developing models and algorithms for analysis of such expressive content (ii) individuating which motion cues are involved in conveying the actorpsilas expressive intentions to portray four emotions (anger, joy, relief, sadness) via a scenario approach. The paper discusses the experiment in detail with reference to related conceptual issues, developed techniques, and the obtained results.

Glowinski, D., Camurri, A., Volpe, G., Dael, N., & Scherer, K. (2008). Technique for automatic emotion recognition by body gesture analysis. In Computer Vision and Pattern Recognition Workshops. IEEE Computer Society Conference, June (pp. 1-6). PDF

Valutazione degli errori cognitivi da disattenzione

Abstract: Vi sono contesti (e.g., guida di mezzi di trasporto) in cui l’errore umano può comportare costi non trascurabili in termini di efficienza e sicurezza e un ruolo centrale in questo senso è giocato dalla disattenzione. Nel presente studio si è proceduto alla validazione italiana del Attention Related Cognitive Errors (ARCES, Cheyne et al. 2006), un test mirato alla valutazione di errori dovuti all’attenzione sostenuta. Un primo campione di soggetti (N = 119) ha completato una batteria comprendente ARCES, una misura di presenza mentale (Mindful Attention Awareness Scale – MAAS, Warren et al. 2003), il Cognitive Failure Questionnaire (CFQ), (Broadbent et al., 1982; versione italiana di Mecacci et al., 2004), e due questionari per la valutazione della memoria prospettica e/o retrospettiva: Questionario di Autovalutazione della Memoria Prospettica (QMP, Cicogna et al., 1997) e Prospective and Retrospective Memory Questionnaire (PRMQ, Smith et al., 2000); un secondo campione (N = 25) ha completato ARCES, MAAS, Everyday Memory Failure Scale (MFS, Cheyne et al. 2006), CFQ e QMP, insieme al Sustained Attention to Response Task (SART, Robertson et al., 1997), una prova comportamentale che rivela la propensione a commettere errori in compiti di attenzione sostenuta e che fornisce due punteggi: tempo di reazione a stimoli yes-go (SART-RT) e numero di errori (SART-ERR). I risultati mostrano che ARCES possiede adeguate coerenza interna (alpha = .82) e validità di costrutto e di criterio, in quanto il punteggio correla in modo sostanziale (r > |.30|) con tutte le misure impiegate, anche se non con età, genere e scolarità. Da entrambi gli studi emerge che ARCES può essere vantaggiosamente utilizzato per l’indagine di costrutti collegati con l’attenzione (e.g., il carico di lavoro cognitivo) e, quando inserito in una batteria multidimensionale come quella impiegata in questo lavoro, per lo screening nella valutazione degli operatori.

Bracco, F., Chiorri, C., & Vannucci, M. (2007). Valutazione degli errori cognitivi da disattenzione. Comunicazione per il Congresso Nazionale sezione di Psicologia Sperimentale AIP, Como, 17-19 Settembre.  PDF