Systems issues, delegation

For brevity s sake we sometimes use "systems" to refer both to safety-enabling elements and to organizational sustaining systems. Much current patient safety activity is focused at the level of these systems. Our (unpublished) survey of the May 2006 activity in the Patient Safety Discussion Forum, an Internet newsgroup sponsored by the National Patient Safety Foundation, revealed that almost 90% of the forum s discussion threads dealt with systems issues. The task of addressing systems issues can be safely delegated provided the... 

Secondly, stmctural features in dmg regulation in countries operating a federal system of government affect the ability of the DRA to monitor dmg distribution throughout the entire country. In Australia, authority over distribution channels is fully delegated to the individual states. As a result, the TGA does not have the authority to assess and control the dmg distribution situation for the whole country. In contrast, the Pharmaceutical Services Division in Malaysia appoints a deputy director of health in each of its 13 states with power to issue licences, carry out inspections and submit reports. Under this arrangement, command and control may be exercised and an official channel established for information flow between the federal and state governments. 

National Pollutant Discharge Elimination System (NPDES) A provision of the Clean Water Act that prohibits discharge of pollutants into waters within the United States unless a special permit is issued by the EPA, a state (where delegated), or a tribal government on an Indian reservation. 

The Licensee is responsible for safety on a NPS and this is delegated to the Station Manager. In the event of a reactor accident, which may involve the release of activity to the environment, the Shift Manager, after reporting the details of the accident to the Station Manager or his nominated deputy, if they are on the station, will declare over the public address system that an emergency situation exists. All station staff and other persons on the site withdraw to nominated assembly areas for a roll call. Instructions may be given to issue potassium iodate tablets. 

At the forefront of engineering innovation in healthcare are ways of interfacing devices such as prosthetic limbs to the peripheral nervous systems and brain [10], These can, for example, aim to allow movement of a prosthetic limb with subconscious control of a type similar to that of natural limbs. Such developments raise issues regarding the nature and status of the delegated action, which is partly controlled by a microprocessor. Provision of non-invasive brain-computer interfaces to aid patients with degenerative conditions such as amyotrophic lateral syndrome (Tocked-in syndrome ) may require very detailed knowledge of how the brain processes information and how this is affected by the condition. 

The following outlines major advances identified within each sector examined by the delegates convened for the Engineering Solutions for Sustainability Materials and Resources international workshop. Common themes that emerged as action items across the sectors include practical and reliable tools/ models for measurement of water, energy/carbon, materials impact and their interactions, as well as technologies/approaches for systemic reduction of the human footprint. Further research and development of these advances is recommended to address pressing materials and resources sustainability issues. 

Each level of leadership should be held accountable for ensuring that channels of communication remain open in all directions about safety concerns and issues. Refer to Chapter 7, Leadership and the Effective Safety Culture , for a discussion on defining roles, responsibility, delegation, authority, and accountability for everyone in the organization (Building an Effective Health and Safety Management System, 1989). 

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