Table 1

Description of the six interacting domains of sociotechnical work system, adopted from Holden et al31 and Carayon et al32

Sociotechnical elementDescriptionExample of influence on SAE
Person(s)The central component of the work systems are the persons involved. This component is not limited to the healthcare professional(s), but also considers the patient and their family, and professionals of supporting services. The characteristics of the professionals and teams can be analysed, focusing on the level of knowledge, level of experience and the perceived workload. Additionally, the teamwork and collaborations are considered. Various patient characteristics (eg, physical, psychological or social) can contribute to a SAE and are therefore be included in the analysis.Patient/family
  • A patient indicates atypical complaints when suffering from a ruptured aneurysm of the abdominal aorta.

  • The family of a patient disputes the treatment chosen and frustrates the care provided.

Healthcare professional(s)
  • A healthcare professional chooses to work after two nights of bad sleep due to personal problems, makes a slip and incorrect medication is being prescribed.

  • An interim surgeon uses an instrument (s)he is unfamiliar with, which results in misapplication.

Other professionals
  • A technician turns off the alarm modus of a patient monitoring system during maintenance by mistake, as a result of insufficient product knowledge.

TasksThe tasks element evaluates characteristics of the tasks of the persons involved. These can be considered by looking at the complexity, variety and ambiguity of the tasks, and observing if they coincide with other tasks. Furthermore, eventual efficiency–thoroughness trade-offs made while performing these tasks must be evaluated.Tasks
  • A radiologist swaps two patients with similar names and conditions and fills in his assessment of a magnetic resonance image in the record for the wrong patient.

Tasks-related efficiency–thoroughness trade-offs
  • It will be checked/done by someone else* – a patient is transferred from a busy emergency department to another ward without performing an ECG, because time is scarce and the personnel expect the nursing ward receiving the patient will take care of this.

  • This way it is much quicker* – instead of following a procedure in which medicine is allocated on the patient ward, accompanied by the patient, a nurse prepares the medicines of all patients together at the nurses’ station bearing a greater risk of making mistakes in swapping medicines.

TechnologiesTechnologies used by the person(s) involved must be evaluated. Important features of the technologies are, for example, how easy they are to use, their accessibility, level of automation, functionality and how easily the technologies can be transported and adopted to other settings. This evaluation is performed preferably by both healthcare professionals and technical experts.
  • A monitor in the operating theatre crashes during surgery resulting in limited visual information for the surgeon.

  • A ventilator on the intensive care unit does not provide an alarm when the ventilated air was not heated and moisturised because the apparatus had become loose.

OrganisationOrganisational factors that contribute to the SAE and/or may influence other elements. This includes an evaluation of material factors, such as financial incentives and the accessibility and availability of resources (eg, time, money, goods and services) as well as social factors (eg, management style, culture, hierarchy, social norms and values).
Since the availability of resources and social factors are analysed in this component, an assessment of the eventual efficiency–thoroughness trade-offs related to social factors and resources is incorporated.
  • The staffing of nurses is so low that during the holiday season the minimum level of experience is not guaranteed.

  • A hierarchical relationship between a resident and his supervisor forms a barrier to call during a night shift. Instead, the resident saves all his questions until the next day.

Efficiency–thoroughness trade-offs related to the organisation
  • We always do it in this way here* – an efficient, but unsafe, workaround—a way of temporarily addressing workflow problems—is taught to new nurses.

  • It is not my/our responsibility* – after transferring a cardiac patient from the cardiology ward to the intensive care unit, the cardiologist does not feel responsible for this patient anymore, while the patient is, among other things, still suffering from cardiac instability.

Physical environmentFactors that define the physical environment such as lighting, noise, vibrations, temperature, the physical arrangement of the room(s) and the available space and air quality.
  • Noise on an emergency department disturbs the communication between a nurse and a physician leading to a miscommunication about the volume of medicine.

  • The physical arrangement of a door, bed and other furniture in an emergency department room impedes the crashcar from being positioned inside the room, which hinders the rapid response team in their interventions.

External environmentFactors on a macrolevel that might affect decisions on a microlevel in the sociotechnical work systems and procedures.
  • Shortages in the labour market may lead to a deficiency of qualified nurses.

  • A budget cut and sustainability policy, aimed at reducing water waste, might lead to a faulty legionella bacteria prevention protocol.

  • *The efficiency–thoroughness trade-off descriptions are adopted from Hollnagel.55