Work Practice, Safety and Heedfulness : Studies of Organizational Reliability in Hospitals and Nuclear Power Plants

Abstract: The study of safety in complex systems has focused on different issues over the past decades. This focus was often linked to the conclusions of previous accidents' / incidents' analyses. When accidents were attributed to technical causes, safety research focused on technical developments. When they were later attributed to 'human errors', safety research focused on this 'component'. And when, since the mid-eighties accidents have been attributed to 'organizational factors ', safety research has focused on these very same 'organizational factors '.The present thesis argues for a 'practice view' over safety to be taken. This view is mainly drawn from the field of research on High Reliability Organizations (HRO). HRO theorists' point of view on safety is that we can operate complex systems safely despite the fact that we have made them so complex that they are prone to 'normal accidents'. Humans involved in the operation of our systems actually create safety. Safety is formed through the adaptation of work practice to local conditions, and this adaptation is part of safe operation. Safety is not only a substantial quality of our socio-technical systems: the discursive dimension of safety actually seems to be a central component of safety creation. However, the adaptive ability of HRO can sometimes become their downfall. Adaptation, which is the backbone of safety, can sometimes be a drawback as well. Consequently, the practice view of safety, proposed in the present work, argues that we need to further comprehend how workpractice evolves over time, and more specifically what are the inherent characteristics of work practice that create this evolution.Empirical studies from health-care and nuclear power generation highlight different details about organizational reliability. For instance, one study of planning at a nuclear power plant draws our attention to the different roles of planning in the organization. Another study, within heath-care, underlines the evolution of work practice in connection with a 'minor' technological innovation.Finally, since understanding safety as a social practice entails an important rethinking of the roles of research in the construction of safety in complex systems, the dissertation ends with a discussion around these roles.