Systemic safety management in anesthesiological practices

Anesthesiological practices are complex activities with inherent risks. Hazard assessment techniques based on cause-effect links and linear reasoning do not adequately represent the actual behavior of modern socio-technical systems, which are characterized by tight couplings and interactions among technical, human and organizational aspects. Analysing hazards following a linear perspective may result in a not completely effective management of process safety. This paper discusses the need for a systemic analysis for healthcare practices, applying such perspective to an anesthesiological process. More specifically, it aims to define process hazards, and unsafe control actions for preoperative and intraoperative anesthesiological activities, extending simple cause-effect reasoning through the System Theoretic Accident Model and Processes (STAMP) and its hazard analysis technique, i.e. System Theoretic Process Analysis (STPA). The outcomes of the study based on qualitative research techniques point out the relevance of a systemic approach, with implications for process management. It is argued that the adoption of strict procedures to constraint the variability of everyday work represents a valuable solution only for some specific tasks, while for many others variability has to be accepted as a means to enhance patient safety in a healthy work environment.