title: Planning safe anesthesia: the role of collective resources management.
abstract: OBJECTIVE
  Anticipation and planning are essential steps of risk management but the mechanisms of planning behavior are incompletely understood, especially the factors including collective work. The aim of this research is to understand how anesthetists plan safe solution to perform anesthesia.
  
  
  METHODS
  A study based on interviews was conducted in two French hospitals. Data processing focused on the main decisions made by 20 anesthetists during two simulated pre-anesthetic consultation. The main decisions made have been identified and the decision criteria have been analyzed.
  
  
  RESULTS
  To ensure patient safety, all anesthetists do not plan the same solution. The rejection or the selection of solutions by each physician rests on two types of criteria: the assessment of risks for the patient and the assessment of resources available to handle the situation. For the latter, the knowledge on the individual skills of each and the adoption of "local benchmark practices" play an essential role.
  
  
  CONCLUSIONS
  Ultra safe performance in highly variable systems cannot be achieved only through standardization but also through the possibility and ability of the subjects to adapt their practices to their own skills and to that of their colleagues. The conditions for the development of this "adaptative safety" are discussed.
authors.affiliation: Centre d'Etudes de l'Emploi (Cee), Noisy-le-Grand, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cuvelier
authors.forename: Pierre
authors.initials: P
authors.lastname: Falzon
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Granry
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Moll
authors.forename: Gilles
authors.initials: G
authors.lastname: Orliaguet
mesh_terms: D000758:Anesthesia / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D000776:Anesthesiology / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D003657:Decision Making; D005602:France; D006801:Humans; D007407:Interviews as Topic; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D016544:Patient Simulation; D017751:Safety Management / Q000379:methods / Q000592:standards*; D000078329:Workforce