Organizational-historical analysis of the "failure to respond to alarm" problems

Large healthcare organizations are complex sociotechnical systems in many senses. Understanding how such complex systems adapt to their internal and external environment may help us devise effective strategies in building robust, high-reliability organizations. In this paper, we report findings of an in-depth study of auditory alarms in acute care settings in an attempt to study complex organizations. Investigations into incidents with adverse outcomes often lead to blames of not responding to auditory alarms which, in most cases, sound at audible levels. We interviewed a number of clinicians and stakeholders to understand the reasons why in some circumstances alarms are not responded to. The findings illustrate a spectrum of reasons that predispose care providers in certain responding patterns, such as large numbers of alarms, confusion of alarms, temporary episodes of high workload, and external economic pressures. We also uncovered a number of proactive interventions at unit and organizational levels that sometimes had unanticipated effects.