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The purpose of this paper is to investigate relationships between workarounds (solutions to handling trade-offs between competing or misaligned goals and gaps in policies and procedures), perceived trade-offs, information security (IS) policy compliance, IS expertise/knowledge and IS demands.

The research purpose is addressed using survey data from a nationwide sample of Swedish white-collar workers (N = 156).

Responses reinforce the notion that workarounds partly are something different from IS policy compliance and that workarounds-as-improvisations are used more frequently by employees that see more conflicts between IS and other goals (r = 0.351), and have more IS expertise/knowledge (r = 0.257). Workarounds-as-non-compliance are also used more frequently when IS trade-offs are perceived (r = 0.536). These trade-offs are perceived more by people working in organizations that handle information with high security demands (r = 0.265) and those who perform tasks with high IS demands (r = 0.178).

IS policies are an important part of IS governance. They describe the procedures that are supposed to provide IS. Researchers have primarily investigated how employees’ compliance with IS policies can be predicted and explained. There has been an increased interest in how tradeoffs and conflicts between following policies and other goals lead employees to make workarounds. Workarounds may leave management unaware of how work actually is done within the organization and may besides getting work done lead to new vulnerabilities. This study furthers the understanding of workarounds and trade-offs, which should be subject to further research.

The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.

The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.

Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.

Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.

Universities are expected to operate with high efficiency, with ever-growing expectations from a rising number of stakeholders in society. From a theoretical perspective economic science does provide frameworks and methods in order to tackle this, with the cornerstone of defining efficiency as a simple relation of a quantity of inputs toward a quantity of outputs. For the practice of university management and policy this does not answer the crucial questions of which inputs and which outputs to measure, and how to ensure the quality aspect of such management approaches. Higher education research can contribute to answering these questions. This chapter outlines a sector-specific framework for efficiency analysis and management, including suggestions regarding how to implement efficiency-improving measures in university settings.

The purpose of this conceptual paper is to develop a model of the hypothesized relationships between investments and outcomes of resilient health care (RHC).

Based on the extant literature, the aforementioned model is described along with proxy measures of its composing variables and a matrix for assessing the cost-effectiveness of RHC instantiations. Additional possible relationships are set out in two propositions for theory testing.

The model conveys that RHC gives rise to both desired and undesired outcomes. Investments moderate the relationships between RHC and its outcomes. Both investments and outcomes can be broadly categorized as either human or technical. Moreover, the propositions refer to what type and how much investment is necessary to perform in a resilient manner, what are the intended or desired outcomes of RHC, for how long and who is affected by these outcomes.

The cost-effectiveness perspective of RHC is new and the proposed model opens opportunities for empirical and theoretical research.

The aim of this review is to examine factors that may explain why other industries are considered ultrasafe while progress toward preventing adverse events in health care is not considered to have reached that level.

The paper is a narrative review.

Despite a decade of intense effort, the problem of patient harm in health care facilities remains a challenge. A recent study of ten hospitals in North Carolina, which have actively engaged in patient safety initiatives, reported rates of adverse events similar to those in the Institute of Medicine report, To Err Is Human in 1999. Seven key issues and their interaction are described.

This review focuses on broad issues that likely impede progress generally, not on individual project or individual hospital program success stories.

The authors believe the difficulty in making significant headway on the patient safety agenda is due in part to the fact that it was always going to be a long (indeed never ending) struggle – aviation for example took almost 60 years to become ultra‐safe – and in part to misunderstanding the nature of the dynamics that are involved in the generation of adverse events in risk critical industries. The paper reflects on the nature of the safety initiatives that health care has tended to focus on, but which have not sufficiently taken note of central concepts of safety science, as well as on features of the health care system itself that have impeded, in the authors' view, progress on enhancing patient safety.

Previous results show that the anesthetists’ activity during the planning phase is aimed at neither identifying risks nor pinpointing the adverse events likely to occur; rather, it is to devise “manageable situations” that are adapted to their own competences. The present paper focuses on the issue of understanding how, in practice, these “manageable situations” are constructed. In particular it wonders if a link between the seniority of anesthetists and the way they design these “manageable situations” may be established.

The paper sought to answer these questions through a qualitative study conducted in partnership with anesthetists. The method, combining interviews and case-based simulation, required that 20 anesthetists “thought aloud”.

Results show that the anesthetists sometimes selected a solution that they themselves and experts viewed as riskier. Why? And who selects a riskier solution? The answer is about workplace learning and the continuous development of experience-based competences. “Manageable situations” appear to be planned situations so as to propose solutions adapted not only to present competences but also for future competences to be developed. In that sense, they are part of a developmental process at work.

These findings have implications for practice and they open pathways for further research studies. They call for rethinking the link between experience and workplace learning.

Trade-offs are unavoidable in a competitive and difficult economic environment, causing a challenge for those wanting to provide consistently high-quality service across all touchpoints in the service delivery ecosystem, included in which is the higher education (HE) sector. This study aims to explore the key factors influencing service trade-offs related to the efforts of academics in Malaysia’s HE sector.

A self-administered questionnaire was distributed to 400 full-time academics from several higher learning institutions in Malaysia. Data were analysed using the partial least squares-structural equation modelling (PLS-SEM) approach.

The results reveal that service trade-offs in the HE sector were heavily influenced by service priorities. Customisation of services, meeting individual student needs, working under immense pressure within tight timeframes and focusing on teaching and research jointly contribute to academics’ service trade-offs in the HE sector. Indeed, the nature of the job necessitates such trade-offs by default, as academics are unable to cancel or postpone classes due to scheduling constraints and the requirement to be physically present during class sessions.

HE administrators and managers should provide academics with adequate resources, effective work allocation and optimal timeframes for task completion, as service priorities are the key factors influencing service trade-offs in Malaysia’s HE sector. The satisfaction of these needs would enable academics’ service priorities and trade-offs to be better balanced, thereby contributing to better operational efficiency, boosting organisational performance and maintaining business sustainability.

The empirical results serve to clarify the key factors influencing service trade-offs in the HE sector, thus expanding the extant literature, which has mostly concentrated on describing the same phenomena in the manufacturing sector. The proposed service trade-offs model would serve as a guideline for operational efficiencies in the HE sector to prevent future recurrence and reduce the potential risk of service disruption, thus mitigating the risk of dissatisfaction.

Surgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built environment (BE), prior studies have focused on the operating room, giving scant attention to support areas. This study takes a broader perspective, aiming at developing BE design knowledge supportive of RP at the surgical service as a whole.

Seven BE design prescriptions developed in a previous work in the context of internal logistics of hospitals, and thus addressing interactions between workspaces, were used as a point of departure. The prescriptions were used as a data analysis framework in a case study of the surgical service of a medium-sized private hospital. The scope of the study included surgical and support areas, in addition to workflows involving patients and family members, staff, equipment, sterile instruments and materials, supplies, and waste. Data collection included document analysis, observations, interviews, and meetings with hospital staff.

Results identified 60 examples of using the prescriptions, 77% of which were related to areas other than the operating rooms. The developed design knowledge is framed as a set of prescriptions, examples, and their association to workflows and areas, indicating where it should be applied.

The design knowledge is new in surgical services and offers guidance to both BE and logistics designers.