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"The frame of this chapter is how clinicians and leaders employed in psychiatric
departments in hospitals experience and cope with patients who commit
suicide while undergoing treatment. The major focus is the phenomenon which in
the Bow-tie model is called “stabilization”. To explore this phenomenon in an empirical
analysis, two concepts of samhandling are introduced, these being coordination
and cooperation. These two concepts are used in an interpretation of what eight
leaders and clinicians report on how they handle working together after a patient
during treatment in a psychiatric hospital has unexpectedly committed suicide.
The findings are that leaders and clinicians have different views on what stabilization
is. Stabilization to the leaders seems to be something they can handle by using
mandatory organizational procedures of coordination. To the clinicians (psychologists
and psychiatrists) however, stabilization is less straightforward. Professional
stabilization is, to them, more important than organizational stabilization, and it
requires another form of interaction – namely, cooperation. Cooperation is, in its
simplest and purest form, a symmetrical way of working together, based on equality
in competence and an unforced relation between the parties. For the purpose of
professional stabilization, this is the form of interaction preferred by the clinicians.
However, these findings are tentative and more research is needed to elaborate why
leaders and clinicians respond as they do after a patient suicide."

Samhandling --- interaction --- suicide --- coordination --- risk --- stabilization --- recovery --- unforeseen

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"The chapter presents a case from a government agency in Norway, where
two assistant directors share a leadership position and must interact extensively. The
main purpose is to highlight some benefits and challenges related to shared leadership
when it comes to risk prevention and handling unforeseen events. The analysis
is based on a relational perspective that emphasizes that successful interaction between
people requires complementary skills, conceptualized as relational skills. The
chapter concludes that the patterns of interaction and relational skills that develop
during shared leadership can help prevent undesirable events. This is partly because
shared leadership can provide increased capacity in identifying risks. Common
experiences in handling risks and unforeseen events may contribute to learning
that in turn provides the potential for further development of the interactional and
relational skills in shared leadership. At the same time, shared leadership entails
some risks that may impact on the prevention and handling of such events. For
instance, interactional challenges that may arise in a shared leadership may prevent
leaders from discovering potential hazards."

Samhandling --- interaction --- shared leadership --- identifying risk --- organizational learning --- unforeseen

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"The main objective of this chapter is to clarify some key and overall theoretical
and conceptual frameworks underlying the research project “Samhandling
Under Risk” (SUR), as discussed in the various chapters of this anthology. The overall
research question is: What are the basic structures of the concept of samhandling under
risk and how can samhandling be created when the conditions are unpredictable?
This chapter explains in particular the terms “samhandling” (SAM), “the Unforeseen”
(UN), “Risk” and “SUR structures”. Furthermore, these concepts are explored more
deeply in relation to each other, which also frames the main approach of the anthology.
As a basis, a specific understanding of “The Nature of the Unforeseen”, an expanded
and customized Bow-tie Model, as well as a clarification of the boundaries
enclosing the research field are compared to traditional risk analysis and training in
what is already known and in dealing with probable threats. Although the individual
studies reported in this anthology also have their own specific angles regarding these
concepts and models, they have nevertheless been based on these. The core focus is
also on learning in the light of organizational learning and SUR. The boundaries, challenges
and the anthology’s focus on learning are also expressed in the more general
and overall question: How can we as a society prepare ourselves for the unforeseen,
the events and threats at the outer reaches of what we have trained for? A more indepth
explanation about the background of this research project is also given in the
preface of the anthology."

Samhandling --- interaction --- unforeseen --- preparedness --- resilience --- risk --- training --- organizational learning

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The authors of this book set out a system of safety strategies and interventions for managing patient safety on a day-to-day basis and improving safety over the long term. These strategies are applicable at all levels of the healthcare system from the frontline to the regulation and governance of the system.There have been many advances in patient safety, but we now need a new and broader vision that encompasses care throughout the patient’s journey. The authors argue that we need to see safety through the patient’s eyes, to consider how safety is managed in different contexts and to develop a wider strategic and practical vision in which patient safety is recast as the management of risk over time. Most safety improvement strategies aim to improve reliability and move closer toward optimal care. However, healthcare will always be under pressure and we also require ways of managing safety when conditions are difficult. We need to make more use of strategies concerned with detecting, controlling, managing and responding to risk. Strategies for managing safety in highly standardised and controlled environments are necessarily different from those in which clinicians constantly have to adapt and respond to changing circumstances.This work is supported by the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.The charity’s aim is a healthier population in the UK, supported by high quality health care that can be equitably accessed. The Foundation carries out policy analysis and makes grants to front-line teams to try ideas in practice and supports research into what works to make people’s lives healthier and improve the health care system, with a particular emphasis on how to make successful change happen.A key part of the work is to make links between the knowledge of those working to deliver health and health care with research evidence and analysis. The aspiration is to create a virtuous circle, using what works on the ground to inform effective policymaking and vice versa. Good health and health care are vital for a flourishing society. Through sharing what is known, collaboration and building people’s skills and knowledge, the Foundation aims to make a difference and contribute to a healthier population.

Health Administration --- Quality Control, Reliability, Safety and Risk --- Quality of Life Research --- Practice and Hospital Management

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"This chapter focus on Norwegian healthcare policies and regulations for
care coordination and patient safety. The Norwegian Coordination Reform implemented
in 2012 emphasizes patient engagement, care pathways, and competence
development in municipal healthcare services. Moreover, protocols for division of
work tasks and collaboration between specialist and municipal healthcare services
are key aspects. The reform identifies fragmented health services and the lack of
coordinated care as main challenges. The authors introduce the concepts of care
coordination, continuity of care and patient handovers, and relate these to patient
safety. Results from a Norwegian observational study, identifying factors affecting
care coordination and patient safety in care transitions between hospital and municipal
care, are presented. Finally, the authors introduce relevant measures to improve
care coordination and patient safety, including the regulatory work and follow-up
of health services through nationwide audits performed by the Norwegian Board of
Health Supervision."

Samhandling --- interaction --- healthcare services --- patient safety --- municipal care --- coordination --- risk --- unforeseen