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 |