Drew Dawson, one of the gurus of sleep research, has written a long and informative piece for Crikey today about the issue of long working hours, fatigue and health service safety.
Dawson contributed to the fatigue risk management guidelines which recently caused Queensland Health some media grief, and today he’s taken us well beyond those headlines. Adelaide surgeon Guy Maddern also wrote about related issues in Crikey this week.
I particularly liked Dawson’s observation that:
“Fatigue risk management is the perfect example of what Tony Blair described as a ‘wicked problem’. That is, one for which the solution is complex, multi-factorial and will require thoughtfulness, flexibility and time. Successful fatigue risk management in health care will require exactly that.”
Using that definition, it seems to me that most problems in health are absolutely wicked.
One Comment
I agree that a lot of health and health system problems are “wicked problems” but I don’t necessarily agree that sleep fits the bill, as the problems are known but exceedingly difficult to address.
The best definition I’ve come across is Martin Stewart-Weeks one*. He suggests that a wicked problem meets the following criteria:
- Evolving interlocking issues and constraints;
- Lack of agreement about what the problem actually is;
- A complex array of stakeholders;
- Constraints on resources and political ramifications; and
- No definitive solutions, with decisions being driven by time pressures.
Wicked problems are unique, technical, without precedent, and *can’t* be solved, only managed.
* From Control to Networks in Colebatch H. Beyond the Policy Cycle, Allen & Unwin: Sydney, 2006, p184-202