Critical Incident Management Research Articles

Dealing with a Crisis--What the Police Have Learnt and What Others Can Learn from the Police

Rob Beckley is Deputy Chief Constable for Avon and Somerset Constabulary. He was previously Head of Race and Minority Policy at New Scotland Yard and Assistant Chief Constable (Crime and Operations) at Hertfordshire Constabulary. Within ACPO, Mr Beckley had policy responsibility for faith issues and led the National Community Tensions Team in its work on community cohesion and public disorder. Julian Birkinshaw is Professor of Strategic and International Management at the London Business School. Professor Birkinshaw writes, consults and teaches on how organizations can become more effective at dealing with changes in their external environment and how they can operate more efficiently on an internal basis. In this article, the authors explain the concept of critical incident management and examine how its introduction into policing has served to foster a set of behaviours that encourage accountability and timely judgement. They argue that despite some high-profile failures, such as in the case of the Soham murders, there have been many more examples where critical incident responses have been successfully applied and managed, so that they never became as prominent or as damaging as the failures.

Sistema de gestión de incidentes críticos y eventos adversos en los ámbitos área, servicio o unidad hospitalarios. Puesta en marcha en tres fases

IntroductionThe purpose of this article is to present a model for clinical risk management based on technological and organisational advances with proven effect. Designed for a single clinical Unit, the model is open to other notification systems and health care clinical units. Material and methodThe model has three implementation phases. The first phase involved studying the existing safety system and objectively measured the culture of patient safety. The second phase included development and implementation of a system for the management of critical incidents with creation of a team of specialists. The third phase was the development of the technological and organizational base for horizontal and vertical integration, for internal and external training, and opening the system to other clinical units. ResultsWe found an unstructured, non-confidential, potentially punitive model of clinical risk management without efficacy criteria. There was an unsatisfactory safety culture level for all of the evaluation issues. The introduction of a system for critical incident management gave the basis for the optimization and evaluation of the patient safety related processes. ConclusionsOur model for clinical risk management is a simple, useful and efficient example for introducing a patient safety strategy in a hospital clinical unit.

Critical Events Simulation for Neonatal and Paediatric Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a form of life support used when conventional management with mechanical ventilation is failing. Depending on the type of ECMO support utilised, it can provide temporary lung support in neonates and children with respiratory failure (usually veno-venous access) and cardiac support (veno-arterial access) particularly around the time of corrective cardiac surgery. Unlike cardio-pulmonary bypass during cardiac surgery, ECMO support is usually provided for a number of days or even weeks. It is essential that this intense and relatively complex form of life support is free from potentially avoidable adverse incidents. We have developed a course for training in critical incident management during an ECMO ‘run’ using clinical event scenarios and based on a high-fidelity patient simulator. We present the development process and our initial thoughts about its use.

Efficiency of critical incident management systems: Instrument development and validation

There is much literature in the area of emergency response management systems. Even so, there is in general a lacuna of literature that deals with the issue of measuring the effectiveness of such systems. The aim of this study is to develop and validate an instrument to measure the critical factors that contribute to the efficiency of decision support in critical incident management systems (CIMS). The instrument presented in this paper has been developed using a CIMS efficiency model that is based on an adaptation of media richness theory, aspects of the national incident management system (NIMS) and interviews with experts on emergency management. The instrument has been validated through a pretest, followed by a pilot test and, finally, a main field test which includes a survey of 76 experts. The final instrument consists of 28 statistically relevant question items, which form eight constructs. The instrument allows communities to assess both strengths and weaknesses of existing systems. This allows communities to better prepare for disasters as it informs both policies and practice on areas of weakness that need addressing.

Reflective Simulation: Enhancing the student’ learning experiences through structure and guidance

Introduction Reflective practice in nursing, medicine and allied health care disciplines is now commonly recognised in UK professional benchmark statements and seen as a desirable outcome for both clinical practice and continuing professional development (CPD). Described as process through which students can purposefully revisit, analyse, evaluate and learn from experiences, the Reflective Simulation Framework (RSF)1 is designed to structure and guide the students’ experiences in ways that foster deep learning about critical incident management. The underlying pedagogies are grounded in the works of Dewey2 and Kolb3. The Reflective Simulation Framework The (RSF) which comprises six dimensions is an iterative learner centred model which can be used flexibly to explore the simulated experience in order to enhance learning and practice and crucially act as a basis for multiple feedback systems Discussion Currently, there is a lack of structured guidance in the field Simulation learning to promote reflective practice4,5. This is especially the case before students attend simulation activities. As the use of simulation based learning has increased considerably, a real need has been identified to provide students and instructors with a more concrete approach to engaging with reflective learning. We propose that unlike other approaches to learning the RSF can be used as an advanced organiser to help accelerate the learning process not just after the event but prior to and during simulation experiences. We believe that the RSF model should be handed out to students alongside other introductory materials as part of the overall orientation to simulation. The definitions, features and use of RSF when combined present a creative and flexible approach to reflective simulation learning and teaching in structured and guided ways. The visual representation of reflective processes promotes reflection as a conscious formal activity with purposeful outcomes for personal development and enhanced professional practice. Conflict of Interest: Authors indicated they have nothing to disclose.Figure

Critical Incident Analysis and Management – Call for Volunteers

Critical Incident Analysis and Management – Call for Volunteers

Brief encounters of aggression and violence in primary care: a team approach to coping strategies.

Our aim was to investigate the extended primary care team's experience of aggression and violence from patients, in order to promote the formulation of multiprofessional team procedures for critical incident management and organizational development. A qualitative study based on in-depth interviews and focus groups with primary health care teams and community staff was carried out in one inner London and one outer London health authority area. Key issues and themes were derived from transcripts of 30 individual interviews and five focus group discussions. Key issues identified during interviews informed focus group discussions. The focus groups identified existing and proposed responses to the problem of aggressive encounters. No practice had a protocol for dealing with incidents, and few kept records, but the incidence of violence and aggression was perceived to be increasing. Receptionists were most at risk, and relied on experience to cope with incidents. Due to being usually excluded from team meetings, they were not able to benefit from peer support and advice. Negative management tactics, such as patient appeasement or exclusion, were the norm. Recommendations include formal record keeping, communication skills training and team responsibility for incident management and for the development of practice protocols to ensure the consistency of response. Improvements to the working environment need to balance staff security with patient-friendliness, and constitute only one aspect of a measured response to the problem. The success of the focus group format in this context suggests that entire primary care teams could be led in workshops to review their experiences and formulate responses on an inclusive, multidisciplinary basis. These findings fit in with the concept of systems analysis in risk management protocols. We recommend that the team collectively formulate protocols for managing threatening encounters, with agreed mechanisms and thresholds for recording and reporting. Together with improved support systems within the extended teams and post-incident analysis of adverse events, this would allow a formal approach to identifying systematic weaknesses and solutions that benefit the staff involved.

Critical Incident Intelligence Gathering, Coordination and Analysis

ABSTRACT Critical incident response and management operations require an immediate and continuous flow of intelligence. The continuous flow of information becomes the lifeblood of a critical incident. All response elements whether on-scene or in a support role must have the ability to synchronize and contribute to the intelligence process. Crisis negotiators perform a vital function with intelligence gathering, intelligence analysis, and intelligence coordination. Negotiators must have the training and ability to process information quickly and accurately in order to support a commander's decision-making process. Police administrators and line commanders must be proactive in critical incident response planning, preparation and the provision of training.

A Survey of LEA Guidance and Support for the Management of Crises in Schools

This study examines and discusses the guidance and support offered to schools by 17 local education authorities in respect of crisis management. After outlining some of the main features of the documents studied, it concludes that there is a considerable variation in the amount of guidance given to schools. The study suggests that every school should have a member of the Senior Management Team who has critical incident management planning as part of their job description. It is noted that the guidance given by all the local education authorities surveyed focuses on accidents on school trips and it is suggested that more attention needs to be paid to planning for dealing with floods, fires, structural damage and incidents such as those which occurred at Dunblane. More attention too, it suggests, needs to be paid to preventive and precautionary measures: all but one of the local education authorities surveyed restricted most of their guidance to coping with a crisis after it had occurred.

The Role of Policy in Creating a Supportive Social Context for the Management of Loss Experiences and Critical Incidents in School Communities

School communities globally are experiencing traumatic events that have the potential to affect the following: the mental health of those involved; the academic progress of students; the work life of teachers; and the public perception of schools as safe physical and psychosocial environments. This potentially widespread impact necessitates the adoption of a comprehensive management strategy. This article describes suggestions for management of these incidents based on the following: a social construction of grief; an ecological public health perspective on loss and grief; and research on educational change. Elements of a supportive school environment will be used to exemplify the proposed approach. The crucial element of the supportive environment was the development of a critical incident management plan. This “working policy” demonstrated coherence between practices and philosophy, indicated a proactive approach for loss and grief and critical incident management and a legally accountable organization.

Book Reviews

Books reviewed:Conor Gearty (Ed.) TerrorismLaurence Miller, W. W. Norton Shocks to the System: Psychotherapy of Traumatic Disability SyndromesJane Franklin (Ed.) The Politics of Risk SocietyChester A. Crocker and Fen Osler Hampson with Pamela Aall (Eds.) Managing Global Chaos of and Responses to International ConflictChris Chapman and Stephen Ward Project Risk Management: Processes, Techniques and InsightsGene I. Rochlin Trapped in the Net: The Unanticipated Consequences of ComputerizationRhona Flin Sitting in the Hot Seat: Leaders and Teams for Critical Incident Management

A wellness approach to the management of traumatic loss in schools: an examination of teachers' stress responses and coping strategies, and school response mechanisms.

This study was a qualitative examination of the stress responses and coping strategies of 21 teachers (12 women & 9 men), and school response mechanisms following a critical incident involving the death of a student or colleague. In order to explore the possibility that deaths of a relatively common nature can evoke high stress and grief responses, exceptional or large scale events, or those generating widespread public or media attention, were excluded. Findings showed that the impact on participants was high, and included cognitive, emotional, functional and physiological responses. Six discrete wellness factors, considered to contribute to effective coping, were identified: emotional and practical support, active involvement, responding according to individual need, access to information, readiness, and leadership. A salutogenic (wellness) approach to critical incident management was considered to provide a comprehensive and effective model for supporting individual teachers and the school in mobilising coping and restorative strategies and mechanisms. Implications for critical incident management in schools, and directions for further study, are discussed.

Resistance factors in critical incident management

This paper explores resistance and contextual variables which impinge on the successful implementation, adoption and management of critical incidents. Time constraints and uncertainty are two constant and overriding forces within the critical incident framework. These implicit pressures interact within different levels of the culture of the organisation, school or community. Two distinct yet interactive levels are discussed. They are the idiographic or personal domain, and the nomothetic or social system domain. The idiographic dimension includes personality variables as well as the role of the key stakeholders in critical incident management. The nomothetic dimension involves the organisation's social system, which has process variables and linkage mechanisms which need to be understood so that successful critical incident management can be ensured.Resistance, or refusal to comply, has been a common pervading and often intangible force in schools in relation to the management of critical incidents. My perception of this opposition to the design and implementation of critical incident management plans has been the driving force for me to think about reasons why this is so, to collect research and to write this paper.On a continuum, resistance and its opposite, acceptance, represent the endpoints of a critical incident management perspective. Opposition or resistance to a new idea, in this case, critical incident management, can be counteracted by guidance, knowledge and involvement. These are the principles of two well known models of problem solving: the Discount Hierarchy used in the NSW Child Protection Program (1988) and the Concerns Based Adoption Model (CBAM, Loucks etal., 1975).

Performance Appraisal as an Aid in Personnel Decisions: Linkages between Techniques and Purposes in North Carolina Municipalities

This study surveys general factors essential to effective performance appraisal (related to the employment of performance standards and employee participation in their construction), examines specific types of appraisal systems (graphic rating scales, forced-choice, paired-comparison, behaviorally anchored rating scales, and appraisal-by-objectives), and explores system add-on options (critical incident, appraisal interview, self-appraisal, interim appraisals, and special management appraisals) that enhance the effectiveness of appraisal. These are examined vis-à-vis the purposes to which performance appraisals are put (training, reassignment, reinstatement, promotion, demotion, retention, dismissal, merit pay, and bonuses). General performance standards, specific appraisal types, or various productivity add-ons appear to be moderately linked (with Phi-statistics measured between .2 and .4) to their employment as aids in personnel decision making. Although we must note that these associations are not themselves causal evidence, these practices are indeed designed as aids for making personnel decisions. Their introduction into municipal performance appraisal is clearly tied to a willingness among those cities to employ those appraisals as aids in making substantive personnel decisions.

Infant abductions in health care: Critical incident response

Critical Incident Management provides a coordinated response in which all of the players have both an understanding of their role and its coordination with the overall plan. Continuing operations of the hospital must continue but care and concern needs to be directed to the family which is suffering. The goal of our response is the safe return of the newborn.