Organisational interfaces, risk potentials and quality losses in nursing: A multi-level approach

At first glance, 'risk and safety in medicine' seems to be associated with accidents, deficiencies in ergonomics and more or less concrete technical a spects of work design. From an organisational psychologist's perspective, r isks are also related to poorly designed working systems and an insufficien t level of system integration. The consequences of risk potentials are much more than damage and injury, they may be integrated within the broader con cept of quality losses. Accordingly, risk potentials can be conceptualised as frictional losses at organisational interfaces between different social or technical subsystems respectively between different organisational level s, which will probably result in quality losses in the long run. Against th e background of the 'Organisation-Activity-Individual-Approach', a theoreti cal concept which provides a methodology for multi-level analysis of work i n organisations, the paper focuses on the relationships between organisatio nal interfaces, risk potentials and quality losses at different levels of t he hospital organisation with respect to disturbances (e.g, interruptions) within the nursing subsystem due to taylo ristic forms of work organisation; disturbances (e.g. hindrances) at the interface between nursing tasks and t echnological performance conditions; disturbances (e.g. communication problems) at the interface between the nur sing and medicine subsystems due to poor system-integration; disturbances (e.g. non-usability) at the interface between nursing process and technological, computer-assisted solutions. Empirical evidence from several studies in different hospital systems provi des practical illustrations and points to the substantial costs of badly de signed working systems in hospitals.