Much has been written on the concept of work as done (WAD) vs. work as imagined (WAI). Essentially, the idea is that the work done at the sharp-end / on the shop floor (i.e. WAD) differs significantly from that which is documented in standard operating procedures (WAI). Understanding this difference is key to understanding why adverse events occur, yet this approach is often overlooked: the prevailing approach to adverse incident analysis is often based on an assumption that WAI is the reality.
Understanding WAD is not easy and probably requires a completely different approach to commonly used methods like Root Cause Analysis (RCA). WAD depends on variability of performance including improvisation and work-arounds. This variability is essential for socio-technical systems (such as health-care) to function, but this variability can also be the source of failures. Unfortunately, adverse incident analyses tend only to highlight the negative side of human variability, so efforts to make systems safer often result in the imposition of more and more constraints.
How can we understand WAD better? In particular, is it possible to capture the positive side of variable performance?
Capturing WAD necessarily requires real workers describing how real work is done. Hence, the understanding must come from the ‘sharp-end’. Various methodologies exist, but I would advocate the value of excellence reporting. The vast majority of LfE reports describe non-technical skills whereby success has occurred despite difficult conditions. These non-technical skills (e.g. generosity, kindness, going the extra mile) are not featured in WAI, yet they are assumed. It is my contention that positive human interactions are a core component of WAD and should be actively noted and appreciated. LfE is designed to do just that.
Adrian
