Balancing clinical team perceptions of the workplace : applying 'work domain analysis' to pediatric cardiac care

The safety, reliability, and stability of the pediatric cardiology workplace are continuously challenged. Known factors include the complexity of patient care, keeping up to date with evidence based practice, harnessing the implications of innovations in technology, and adapting to changes in the structure of health services and facilities. The differences between individual clinical team perspectives and impressions formed by other teams across the organization produce divergent perspectives on clinical work. This paper makes a case for investing in a social science framework entitled 'work domain analysis' to better understand how health teams function reliably within the wider healthcare organization. Work domain analysis was developed to equip people in complex work environments with the skills and awareness to identify and adjust the margins for safety in normal work by making the boundaries between management imperatives, workload and safety (in this case, pediatric cardiac care) more apparent to a wider range of people. Healthcare can no longer afford to be precious about methods adopted from other industries due to the high complexity of the clinical workplace. The paper outlines an approach to work domain analysis that can greatly enhance the engagement and awareness of clinicians. The opportunities for practical applications of work domain analysis to pediatric care are discussed.