Quality & Safety Recap Literature
Challenges to (positively) influence
quality and safety.
The challenges influence each other in
both a negative and a positive way.
How can we learn from things that go
right and wrong (safety I and II)?
Each challenge needs to be balanced
because every challenge has its
downsides.
Many challenges are about a
continuous process/development.
Structural challenge (week 1)
Structuring, planning, and coordinating quality efforts from a process perspective. Too much focus on
structure can lead to bureaucracy. There is never one definitive structure, it is always ongoing, a
continuous effort.
Decoupling: work organizations do to create a buffer for (external) influences.
Gaps between policies and implementations, difference between WAI and WAD.
Workarounds.
o Policy-practice decoupling: rules seem to be used/implemented when executors visit,
however they are not really used. Policies are disconnected from daily practices.
o Means-end decoupling: rules and policies are implemented but they are not linked to
outcomes as intended.
Ex-post theory: improvement efforts. How can we learn from workarounds? After the event (ex-
post) having a close look at what was actually the idea, discuss with others, what happened?
Use more social theory and existing literature to see what happened.
Cultural challenge (week 2)
Shared and collective meaning within an organization. What are the attitudes towards quality and
safety?
Soft autonomy: a state of autonomy in which the autonomy is restricted by external pressure
for monitoring, but (through active involvement) leaves considerable freedom for professionals
Challenges to (positively) influence
quality and safety.
The challenges influence each other in
both a negative and a positive way.
How can we learn from things that go
right and wrong (safety I and II)?
Each challenge needs to be balanced
because every challenge has its
downsides.
Many challenges are about a
continuous process/development.
Structural challenge (week 1)
Structuring, planning, and coordinating quality efforts from a process perspective. Too much focus on
structure can lead to bureaucracy. There is never one definitive structure, it is always ongoing, a
continuous effort.
Decoupling: work organizations do to create a buffer for (external) influences.
Gaps between policies and implementations, difference between WAI and WAD.
Workarounds.
o Policy-practice decoupling: rules seem to be used/implemented when executors visit,
however they are not really used. Policies are disconnected from daily practices.
o Means-end decoupling: rules and policies are implemented but they are not linked to
outcomes as intended.
Ex-post theory: improvement efforts. How can we learn from workarounds? After the event (ex-
post) having a close look at what was actually the idea, discuss with others, what happened?
Use more social theory and existing literature to see what happened.
Cultural challenge (week 2)
Shared and collective meaning within an organization. What are the attitudes towards quality and
safety?
Soft autonomy: a state of autonomy in which the autonomy is restricted by external pressure
for monitoring, but (through active involvement) leaves considerable freedom for professionals
