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Table 1 CARE Model 2.0: Types of Misalignment and Adaptation with Descriptions and Examples from our Observations

From: Understanding complex work using an extension of the resilience CARE model: an ethnographic study

Misalignment Type

Description

Observed Example

 Equipment

Equipment shortage and/or equipment is broken, not fit for purpose, or faulty

There are not enough computers on the ward

 Staffing

Unexpected shortage of staff and/or staff skills mix does not fit needs

A staff member calls in sick, leaving the ward short-staffed

 Communication

Message is not accurate, clear, and/or consistent

The medical team is not informed that the consultant has been reassigned to a different team

 Space

Space is poorly designed for purpose

The team meeting takes place in a hallway, lacking privacy and blocking traffic flow through ward

 Process

Process is not efficient, reliable, easy, coordinated, and/or achievable

The patient is medically ready for hospital discharge. It is unsafe for them to discharge home independently, but they do not qualify for an increased package of care

 Workflow

Staff are taken away from the task they are working on to tend to another task

A nurse providing patient care is interrupted with a question from another team member

Adaptation Type

Description

Observed Example

 Extra-role Performance

An individual spontaneously assisting with work that is not their direct responsibility

The ward manager delivers meal trays to help when the ward is busy

 Resource Redistribution

Equipment

Redistributing equipment to areas of greater need

The nurse borrows a glucometer from a neighbouring ward

Staff

Redistributing staff to areas of greater need

The ward borrows an additional nurse from a neighbouring ward when they are short staffed

 Process

Who

Changing who does a process by reshuffling tasks among team members

The consultant leaves to attend to an urgent situation on another ward. The junior doctor and nurse practitioner divide up and complete the outstanding tasks while she is away

How

Changing how a process is done

The computer is not working, so the doctor writes paper notes instead

When

Changing when a process is done

The patient is not available when the nurse tries to give them their medications, so the medications are given later