Leadership and Crew Resource Management in High-Reliability Organizations: A Competency Framework for Measuring Behaviors

High-reliability organisation principles implemented in dentistry

Introduction/objectives Successful dentistry inherently requires high-reliability and situational awareness to provide consistent high-quality care. However, treatment errors still occur in dentistry as they do in medicine. The importance of avoiding error is elevated for dentistry due to the increased frequency of irreversible procedures in each patient interaction compared to non-surgical specialties in medicine. Although a universal protocol for time-out exists, wrong-site procedures are a persistent healthcare issue in dentistry.Data By implementing high-reliability organisations (HROs) principles to dentistry, improved safety and quality can be achieved.Sources There are five essential principles that HROs have been observed to adhere to: preoccupation with failure; situational awareness/sensitivity to operations; a reluctance to simplify; deference to expertise; and commitment to resilience. Deep examination of the potential vulnerabilities in dentistry, using HRO ideology will create effective process improvement strategies. It fosters a culture of accountability using systematic problem-solving as opposed to condemnation.Study selection Implementation of HRO principles will improve the existing universal time-out process, while placing quality and performance at the central focus of strategic success.Conclusions Dentists can adopt these HRO principles into their practices to create effective process improvement strategies.

Adaptive Resilience of Complex Safety-Critical Sociotechnical Systems: Toward a Unified Conceptual Framework and Its Formalization

Resilience is commonly understood as the capacity for a system to maintain a desirable state while undergoing adversity or to return to a desirable state as quickly as possible after being impacted. In this paper, we focus on resilience for complex sociotechnical systems (STS), specifically those where safety is an important aspect. Two main desiderata for safety-critical STS to be resilient are adaptive capacity and adaptation. Formal studies integrating human cognition and social aspects are needed to quantify the capacity to adapt and the effects of adaptation. We propose a conceptual framework to elaborate on the concept of resilience of safety-critical STS, based on adaptive capacity and adaptation and how this can be formalized. A set of mechanisms is identified that is necessary for STS to have the capacity to adapt. Mechanisms belonging to adaptive capacity include situation awareness, sensemaking, monitoring, decision-making, coordination, and learning. It is posited that the two mechanisms required to perform adaptation are anticipation and responding. This framework attempts to coherently integrate the key components of the multifaceted concept of STS adaptive resilience. This can then be used to pursue the formal representation of adaptive resilience, its modeling, and its operationalization in real-world safety-critical STS.

Research and Training in Culturo-Behavior Science

Culturo-behavior science (CBS) is a developing area and recently formalized specialization in behavior science that brings together principles and techniques from behavior analysis (e.g., Skinner, 1953), behavioral systems analysis (e.g., Brethower, 2008), cultural analysis (e.g., Glenn et al., 2016), and cultural systems analysis (Mattaini, 2020). Culturo-behavior scientists typically work within a selectionist and/or (ecological) systems perspective to advance our understanding of how cultural phenomena develop and change over time and how more effective cultures and systems can be designed (Cihon & Mattaini, 2019, 2020b). The purpose of the current article is to describe CBS, to introduce the recently formulated Association for Behavior Analysis International verified course sequence (VCS) and certificate program in CBS, and to present different pathways to training in CBS. We do this through the presentation of examples from the literature and from four universities that have adopted the CBS VCS and certificate program that are illustrative of how different programs may approach research and training in CBS.

Reliability, uncertainty and the management of error: New perspectives in the COVID‐19 era

This essay argues for the importance of error as an organizing concept in the management of hazardous technical systems to high levels of reliability and safety. The concept of “error” has been essential to the development of high reliability organizations (HROs). As practiced in HROs, error management has also been an important strategy for the management of uncertainty. “Uncertainty” has been conceived by some analysts as a condition that can convey little or no reliable information about its own boundary conditions or its specific threat to the operation of complex systems. The argument here is that uncertainty is differentiated and specified in HROs and provides important information in relation to error. Uncertainty does not, in the special context of HROs, end the possibility and practice of reliable management. In fact, error in HROs can be a starting point for the further analysis of ways in which uncertainty itself can be managed reliably. But the argument offered here does not mean that uncertainty does not challenge reliability in other settings. The COVID‐19 pandemic is offered as an example of how uncertainties may invalidate even the application of "reliability" as a performance standard in certain domains of management and policy.

Implementation Science, Behavior Analysis, and Supporting Evidence-based Practices for Individuals with Autism

Although applied behavior analysis researchers have created efficacious treatment and intervention practices for children and youth with autism spectrum disorder (ASD), there is a gap between research and practice. Implementation Science (IS) and Organizational Behavior Management (OBM), based with Applied Behavior Analysis, are two parallel fields that could close this gap. This paper provides descriptions of both IS and OBM, highlighting their commonalities and unique featuers. The paper concludes with examples of how researchers have used IS and OBM to promote practitioners' use of evidence-based practices and services for children and youth with ASD.