{"id":"https://openalex.org/W2161267607","doi":"https://doi.org/10.1109/icsmc.2007.4414202","title":"Ironies of improvement: organizational factors undermining resilient performance in healthcare","display_name":"Ironies of improvement: organizational factors undermining resilient performance in healthcare","publication_year":2007,"publication_date":"2007-10-01","ids":{"openalex":"https://openalex.org/W2161267607","doi":"https://doi.org/10.1109/icsmc.2007.4414202","mag":"2161267607"},"language":"en","primary_location":{"id":"doi:10.1109/icsmc.2007.4414202","is_oa":false,"landing_page_url":"https://doi.org/10.1109/icsmc.2007.4414202","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"2007 IEEE International Conference on Systems, Man and Cybernetics","raw_type":"proceedings-article"},"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5065564866","display_name":"Shawna J. Perry","orcid":null},"institutions":[{"id":"https://openalex.org/I61515104","display_name":"University of Florida Health Science Center","ror":"https://ror.org/0419bgt07","country_code":"US","type":"education","lineage":["https://openalex.org/I61515104"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Shawna Perry","raw_affiliation_strings":["Department of Emergency Medicine, University of Florida Health Science Center/Jacksonville, Jacksonville, FL, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Emergency Medicine, University of Florida Health Science Center/Jacksonville, Jacksonville, FL, USA","institution_ids":["https://openalex.org/I61515104"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032820068","display_name":"Sandra McDonald","orcid":"https://orcid.org/0000-0002-6241-0772"},"institutions":[{"id":"https://openalex.org/I4210128115","display_name":"Baptist Medical Center Jacksonville","ror":"https://ror.org/037ybm139","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128115"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sandra McDonald","raw_affiliation_strings":["Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA","institution_ids":["https://openalex.org/I4210128115"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5035943734","display_name":"Brandon Anderson","orcid":"https://orcid.org/0000-0001-6502-9216"},"institutions":[{"id":"https://openalex.org/I4210128115","display_name":"Baptist Medical Center Jacksonville","ror":"https://ror.org/037ybm139","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128115"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Brandon Anderson","raw_affiliation_strings":["Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA","institution_ids":["https://openalex.org/I4210128115"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5064761794","display_name":"Thang Quang Tran","orcid":null},"institutions":[{"id":"https://openalex.org/I4210128115","display_name":"Baptist Medical Center Jacksonville","ror":"https://ror.org/037ybm139","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128115"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Thang Tran","raw_affiliation_strings":["Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA","institution_ids":["https://openalex.org/I4210128115"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5040072888","display_name":"Robert L. Wears","orcid":"https://orcid.org/0000-0001-9826-954X"},"institutions":[{"id":"https://openalex.org/I4210128115","display_name":"Baptist Medical Center Jacksonville","ror":"https://ror.org/037ybm139","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128115"]},{"id":"https://openalex.org/I47508984","display_name":"Imperial College London","ror":"https://ror.org/041kmwe10","country_code":"GB","type":"education","lineage":["https://openalex.org/I47508984"]}],"countries":["GB","US"],"is_corresponding":false,"raw_author_name":"Robert Wears","raw_affiliation_strings":["Clinical Safety Research Unit, Imperial College London, London, UK","Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Clinical Safety Research Unit, Imperial College London, London, UK","institution_ids":["https://openalex.org/I47508984"]},{"raw_affiliation_string":"Patient Safety Officer, Shands Jacksonville Medical Center, Jacksonville, FL, USA","institution_ids":["https://openalex.org/I4210128115"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":1.0045,"has_fulltext":false,"cited_by_count":2,"citation_normalized_percentile":{"value":0.78566075,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":"3413","last_page":"3417"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10809","display_name":"Occupational Health and Safety Research","score":0.9994000196456909,"subfield":{"id":"https://openalex.org/subfields/3614","display_name":"Radiological and Ultrasound Technology"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10809","display_name":"Occupational Health and Safety Research","score":0.9994000196456909,"subfield":{"id":"https://openalex.org/subfields/3614","display_name":"Radiological and Ultrasound Technology"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13690","display_name":"Quality and Safety in Healthcare","score":0.9959999918937683,"subfield":{"id":"https://openalex.org/subfields/3607","display_name":"Medical Laboratory Technology"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10508","display_name":"Patient Safety and Medication Errors","score":0.98580002784729,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/unintended-consequences","display_name":"Unintended consequences","score":0.7822080850601196},{"id":"https://openalex.org/keywords/resilience","display_name":"Resilience (materials science)","score":0.6826712489128113},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.6174479722976685},{"id":"https://openalex.org/keywords/patient-safety","display_name":"Patient safety","score":0.606917142868042},{"id":"https://openalex.org/keywords/healthcare-system","display_name":"Healthcare system","score":0.5779134631156921},{"id":"https://openalex.org/keywords/work","display_name":"Work (physics)","score":0.5337632298469543},{"id":"https://openalex.org/keywords/risk-analysis","display_name":"Risk analysis (engineering)","score":0.5302671194076538},{"id":"https://openalex.org/keywords/psychological-resilience","display_name":"Psychological resilience","score":0.5118173956871033},{"id":"https://openalex.org/keywords/control","display_name":"Control (management)","score":0.4625927805900574},{"id":"https://openalex.org/keywords/yield","display_name":"Yield (engineering)","score":0.4566253423690796},{"id":"https://openalex.org/keywords/business","display_name":"Business","score":0.4518255591392517},{"id":"https://openalex.org/keywords/healthcare-worker","display_name":"Healthcare worker","score":0.42592304944992065},{"id":"https://openalex.org/keywords/work-systems","display_name":"Work systems","score":0.4223426878452301},{"id":"https://openalex.org/keywords/process-management","display_name":"Process management","score":0.4195353388786316},{"id":"https://openalex.org/keywords/knowledge-management","display_name":"Knowledge management","score":0.3845970034599304},{"id":"https://openalex.org/keywords/psychology","display_name":"Psychology","score":0.3437575101852417},{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.3412117660045624},{"id":"https://openalex.org/keywords/operations-management","display_name":"Operations management","score":0.3334500193595886},{"id":"https://openalex.org/keywords/public-relations","display_name":"Public relations","score":0.3227006196975708},{"id":"https://openalex.org/keywords/engineering","display_name":"Engineering","score":0.2346067726612091},{"id":"https://openalex.org/keywords/political-science","display_name":"Political science","score":0.20138999819755554},{"id":"https://openalex.org/keywords/social-psychology","display_name":"Social psychology","score":0.18667760491371155}],"concepts":[{"id":"https://openalex.org/C2776889888","wikidata":"https://www.wikidata.org/wiki/Q1135789","display_name":"Unintended consequences","level":2,"score":0.7822080850601196},{"id":"https://openalex.org/C2779585090","wikidata":"https://www.wikidata.org/wiki/Q3457762","display_name":"Resilience (materials science)","level":2,"score":0.6826712489128113},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.6174479722976685},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.606917142868042},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.5779134631156921},{"id":"https://openalex.org/C18762648","wikidata":"https://www.wikidata.org/wiki/Q42213","display_name":"Work (physics)","level":2,"score":0.5337632298469543},{"id":"https://openalex.org/C112930515","wikidata":"https://www.wikidata.org/wiki/Q4389547","display_name":"Risk analysis (engineering)","level":1,"score":0.5302671194076538},{"id":"https://openalex.org/C137176749","wikidata":"https://www.wikidata.org/wiki/Q4105337","display_name":"Psychological resilience","level":2,"score":0.5118173956871033},{"id":"https://openalex.org/C2775924081","wikidata":"https://www.wikidata.org/wiki/Q55608371","display_name":"Control (management)","level":2,"score":0.4625927805900574},{"id":"https://openalex.org/C134121241","wikidata":"https://www.wikidata.org/wiki/Q899301","display_name":"Yield (engineering)","level":2,"score":0.4566253423690796},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.4518255591392517},{"id":"https://openalex.org/C3020329203","wikidata":"https://www.wikidata.org/wiki/Q11974939","display_name":"Healthcare worker","level":3,"score":0.42592304944992065},{"id":"https://openalex.org/C135302770","wikidata":"https://www.wikidata.org/wiki/Q629132","display_name":"Work systems","level":3,"score":0.4223426878452301},{"id":"https://openalex.org/C195094911","wikidata":"https://www.wikidata.org/wiki/Q14167904","display_name":"Process management","level":1,"score":0.4195353388786316},{"id":"https://openalex.org/C56739046","wikidata":"https://www.wikidata.org/wiki/Q192060","display_name":"Knowledge management","level":1,"score":0.3845970034599304},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.3437575101852417},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.3412117660045624},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.3334500193595886},{"id":"https://openalex.org/C39549134","wikidata":"https://www.wikidata.org/wiki/Q133080","display_name":"Public relations","level":1,"score":0.3227006196975708},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.2346067726612091},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.20138999819755554},{"id":"https://openalex.org/C77805123","wikidata":"https://www.wikidata.org/wiki/Q161272","display_name":"Social psychology","level":1,"score":0.18667760491371155},{"id":"https://openalex.org/C121332964","wikidata":"https://www.wikidata.org/wiki/Q413","display_name":"Physics","level":0,"score":0.0},{"id":"https://openalex.org/C78519656","wikidata":"https://www.wikidata.org/wiki/Q101333","display_name":"Mechanical engineering","level":1,"score":0.0},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.0},{"id":"https://openalex.org/C192562407","wikidata":"https://www.wikidata.org/wiki/Q228736","display_name":"Materials science","level":0,"score":0.0},{"id":"https://openalex.org/C97355855","wikidata":"https://www.wikidata.org/wiki/Q11473","display_name":"Thermodynamics","level":1,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C191897082","wikidata":"https://www.wikidata.org/wiki/Q11467","display_name":"Metallurgy","level":1,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1109/icsmc.2007.4414202","is_oa":false,"landing_page_url":"https://doi.org/10.1109/icsmc.2007.4414202","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"2007 IEEE International Conference on Systems, Man and Cybernetics","raw_type":"proceedings-article"}],"best_oa_location":null,"sustainable_development_goals":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":13,"referenced_works":["https://openalex.org/W280663300","https://openalex.org/W568741874","https://openalex.org/W1545008319","https://openalex.org/W1664374833","https://openalex.org/W2010675220","https://openalex.org/W2018485804","https://openalex.org/W2067065954","https://openalex.org/W2134732423","https://openalex.org/W2908119557","https://openalex.org/W4230172260","https://openalex.org/W4255720972","https://openalex.org/W4377985267","https://openalex.org/W6757443655"],"related_works":["https://openalex.org/W4367679432","https://openalex.org/W4248277314","https://openalex.org/W4387098652","https://openalex.org/W4380051107","https://openalex.org/W2964483883","https://openalex.org/W4283465890","https://openalex.org/W4200151279","https://openalex.org/W3087998760","https://openalex.org/W4311406000","https://openalex.org/W2021774402"],"abstract_inverted_index":{"Pressures":[0],"for":[1],"improved":[2],"safety":[3,51],"and":[4,44,50,62,67],"performance":[5,23],"in":[6,72],"healthcare":[7],"often":[8],"are":[9,75],"addressed":[10],"by":[11],"the":[12,53,65,68],"imposition":[13],"of":[14,24,28,55,70],"tighter":[15],"control":[16],"over":[17],"processes":[18],"directed":[19],"at":[20],"producing":[21],"\"perfect":[22],"work.\"":[25],"A":[26],"series":[27],"near-miss":[29],"incidents":[30],"related":[31],"to":[32,58,79],"a":[33],"routine":[34],"hospital":[35],"procedure":[36],"demonstrates":[37],"how":[38],"these":[39],"efforts":[40],"can":[41],"yield":[42],"unintended":[43],"unappreciated":[45],"consequences,":[46],"undermining":[47],"system":[48,80],"resilience":[49,74],"despite":[52],"best":[54],"intentions.":[56],"Attention":[57],"conflicts":[59],"between":[60],"goals":[61],"tasks":[63],"across":[64],"organization":[66],"role":[69],"workers":[71],"creating":[73],"overlooked":[76],"as":[77],"contributors":[78],"safety.":[81]},"counts_by_year":[],"updated_date":"2026-06-11T09:08:48.828518","created_date":"2025-10-10T00:00:00"}