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Papers by Johan Bergström
… of the third Resilience …, 2008
Over-reliance in high-risk industries on prescriptive emergency procedures and the capacity of hi... more Over-reliance in high-risk industries on prescriptive emergency procedures and the capacity of high-fidelity simulation has initiated the search for new steps for training in handling complex and escalating events. A theoretical framework for generic, non-domain specific competencies in proactive crisis management has been developed. The framework contains the following four categories: 1. Information Management, 2. Communication and Coordination, 3. Decision and Implementation, and finally 4. Effect Control. The ability to train the generic competencies has been studied using a crisis management training program in the context of a simulation exercise. A group of Fire Safety Engineers went through the nondomain specific training program and their performance was compared with a control group when doing crisis management exercises in their own domain. This experiment indicates that nondomain specific training improves the participants' ability to manage crises in their own domain and to evaluate their actions and shortcomings when handling complex and dynamic situations.
Journal of Emergency Management, 2008
Recent high-visibility disasters have fueled public and political awareness of the importance of ... more Recent high-visibility disasters have fueled public and political awareness of the importance of managing and mitigating their consequences effectively. In response, various countries have enacted legislation that demands the evaluation of emergency responses so that lessons for improvement can be learned. A series of field and experimental studies were conducted from 2005 to 2007 to assess the ability of firstresponder organizations (eg, fire departments) to learn from failures that occurred during their emergency responses. The departments studied often lacked basic organizational requisites for effectively learning from failure (eg, mutual trust, participation, knowledge of possible learning mechanisms). Further, neither firstresponder training, nor daily practice, seems supported by knowledge of generic competencies necessary for effective crisis management. This not only hampers coordination during a response, but also keeps its evaluation from using a language that could help organizations learn and improve.
Resilience Engineering in Practice a Guidebook, 2010
This paper questions the correspondance between resilience engineering theory and the theoretical... more This paper questions the correspondance between resilience engineering theory and the theoretical fundaments of traditional CRM training, with its related behavior assessments. Reviewing the theoretical roots of CRM it is concluded that such concepts are rather founded in the information processing paradigm hiding the complexities of adaption to rapidly changing situations. An alternative approach to team training and team performance assessment, called Operational Resilience, is introduced. Operational Resilience is rooted in complexity theory and in theorizing cognition as a distributed phenomenon. The most important principles of Operational Resilinece are the focus on processes of coordination and control rather than behaviors, analysis of emergent interactions in multi-professional settings, focus on local production of meaning instead of normative accounds of situation awareness (or similar constructions), and finally analysing how to bridge the gaps caused by the inherent system complexity instead of counting and categorizing errors.
To manage complex and dynamic socio-technical systems places demands on teams to deal with a rang... more To manage complex and dynamic socio-technical systems places demands on teams to deal with a range of more and less foreseeable situations. Three groups of participants with different maritime experiences were studied using the same simulation of a ship to better understand the role of generic competencies (e.g. information management, communication and coordination, decision making, and effect control) play in such high-demand situations. Groups with moderate maritime experience were able to balance contextual knowledge with use of generic competencies to successfully manage unexpected and escalating situations. Novices, lacking contextual knowledge, performed less well. Groups with the most maritime expertise remained committed to presumed procedures and roles and did not perform as well as the other two groups. The results suggest that training to operate complex sociotechnical systems safely and effectively should go beyond procedures and include development of generic competencies. This could provide operators with better tools to enhance organizational resilience in unexpected and escalating situations.
BMC Health Services Research, 2012
Background: This study identifies a promising, new focus for the crisis management research in th... more Background: This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to nonnormal, to pathological and further into a state of emergency or crisis. Discussion: Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications: The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
Ergonomics, 2012
The development of physiologic monitors has contributed to the decline in morbidity and mortality... more The development of physiologic monitors has contributed to the decline in morbidity and mortality in patients undergoing anaesthesia. Diverse factors (physiologic, technical, historical and medico-legal) create challenges for monitor alarm designers. Indeed, a growing body of literature suggests that alarms function sub-optimally in supporting the human operator. Despite existing technology that could allow more appropriate design, most anaesthesia alarms still operate on simple, pre-set thresholds. Arguing that more alarms do not necessarily make for safer alarms is difficult in a litigious medico-legal environment and a competitive marketplace. The resultant commitment to the status quo exposes the risks that a lack of an evidence-based theoretical framework for anaesthesia alarm design presents. In this review, two specific theoretical foundations with relevance to anaesthesia alarms are summarised. The potential significance that signal detection theory and cognitive systems engineering could have in improving anaesthesia alarm design is outlined and future research directions are suggested. The development of physiologic monitors has increased safety for patients undergoing anaesthesia. Evidence suggests that the full potential of the alarms embedded within those monitors is not being realised. In this review article, the authors propose a theoretical framework that could lead to the development of more ergonomic anaesthesia alarms.
phdtheses by Johan Bergström
techreports by Johan Bergström
… of the third Resilience …, 2008
Over-reliance in high-risk industries on prescriptive emergency procedures and the capacity of hi... more Over-reliance in high-risk industries on prescriptive emergency procedures and the capacity of high-fidelity simulation has initiated the search for new steps for training in handling complex and escalating events. A theoretical framework for generic, non-domain specific competencies in proactive crisis management has been developed. The framework contains the following four categories: 1. Information Management, 2. Communication and Coordination, 3. Decision and Implementation, and finally 4. Effect Control. The ability to train the generic competencies has been studied using a crisis management training program in the context of a simulation exercise. A group of Fire Safety Engineers went through the nondomain specific training program and their performance was compared with a control group when doing crisis management exercises in their own domain. This experiment indicates that nondomain specific training improves the participants' ability to manage crises in their own domain and to evaluate their actions and shortcomings when handling complex and dynamic situations.
Journal of Emergency Management, 2008
Recent high-visibility disasters have fueled public and political awareness of the importance of ... more Recent high-visibility disasters have fueled public and political awareness of the importance of managing and mitigating their consequences effectively. In response, various countries have enacted legislation that demands the evaluation of emergency responses so that lessons for improvement can be learned. A series of field and experimental studies were conducted from 2005 to 2007 to assess the ability of firstresponder organizations (eg, fire departments) to learn from failures that occurred during their emergency responses. The departments studied often lacked basic organizational requisites for effectively learning from failure (eg, mutual trust, participation, knowledge of possible learning mechanisms). Further, neither firstresponder training, nor daily practice, seems supported by knowledge of generic competencies necessary for effective crisis management. This not only hampers coordination during a response, but also keeps its evaluation from using a language that could help organizations learn and improve.
Resilience Engineering in Practice a Guidebook, 2010
This paper questions the correspondance between resilience engineering theory and the theoretical... more This paper questions the correspondance between resilience engineering theory and the theoretical fundaments of traditional CRM training, with its related behavior assessments. Reviewing the theoretical roots of CRM it is concluded that such concepts are rather founded in the information processing paradigm hiding the complexities of adaption to rapidly changing situations. An alternative approach to team training and team performance assessment, called Operational Resilience, is introduced. Operational Resilience is rooted in complexity theory and in theorizing cognition as a distributed phenomenon. The most important principles of Operational Resilinece are the focus on processes of coordination and control rather than behaviors, analysis of emergent interactions in multi-professional settings, focus on local production of meaning instead of normative accounds of situation awareness (or similar constructions), and finally analysing how to bridge the gaps caused by the inherent system complexity instead of counting and categorizing errors.
To manage complex and dynamic socio-technical systems places demands on teams to deal with a rang... more To manage complex and dynamic socio-technical systems places demands on teams to deal with a range of more and less foreseeable situations. Three groups of participants with different maritime experiences were studied using the same simulation of a ship to better understand the role of generic competencies (e.g. information management, communication and coordination, decision making, and effect control) play in such high-demand situations. Groups with moderate maritime experience were able to balance contextual knowledge with use of generic competencies to successfully manage unexpected and escalating situations. Novices, lacking contextual knowledge, performed less well. Groups with the most maritime expertise remained committed to presumed procedures and roles and did not perform as well as the other two groups. The results suggest that training to operate complex sociotechnical systems safely and effectively should go beyond procedures and include development of generic competencies. This could provide operators with better tools to enhance organizational resilience in unexpected and escalating situations.
BMC Health Services Research, 2012
Background: This study identifies a promising, new focus for the crisis management research in th... more Background: This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to nonnormal, to pathological and further into a state of emergency or crisis. Discussion: Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications: The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.
Ergonomics, 2012
The development of physiologic monitors has contributed to the decline in morbidity and mortality... more The development of physiologic monitors has contributed to the decline in morbidity and mortality in patients undergoing anaesthesia. Diverse factors (physiologic, technical, historical and medico-legal) create challenges for monitor alarm designers. Indeed, a growing body of literature suggests that alarms function sub-optimally in supporting the human operator. Despite existing technology that could allow more appropriate design, most anaesthesia alarms still operate on simple, pre-set thresholds. Arguing that more alarms do not necessarily make for safer alarms is difficult in a litigious medico-legal environment and a competitive marketplace. The resultant commitment to the status quo exposes the risks that a lack of an evidence-based theoretical framework for anaesthesia alarm design presents. In this review, two specific theoretical foundations with relevance to anaesthesia alarms are summarised. The potential significance that signal detection theory and cognitive systems engineering could have in improving anaesthesia alarm design is outlined and future research directions are suggested. The development of physiologic monitors has increased safety for patients undergoing anaesthesia. Evidence suggests that the full potential of the alarms embedded within those monitors is not being realised. In this review article, the authors propose a theoretical framework that could lead to the development of more ergonomic anaesthesia alarms.