Application of Teleonic Principles in the Search for Systemic Causes of Accidents in Anesthesia

Safety of patients in anesthesia has always been one of the major concerns of the anesthetist. It is clear from studies of safety in general that many accidents and critical incidents occur as the result of latent systemic failures to which a great number of factors contribute (Reason, 1990). An ideal way to approach this problem would be within a systemic framework, such as teleonics, developed by Járos and his co-workers (Cloete, 1999; Járos and Cloete, 1987, 1993). In this framework the events and procedures in anesthesia are considered to be part of a very complex network of process systems (teleons). It is postulated that teleonic uncertainty (telentropy) in this complex network is a factor that might lead to accidents. In a previous paper presented to the World Congress at Toronto in 2000, the principles of teleonics were described in a mathematico symbolic way (Horváth et al., 2000). This paper contains selected examples of application of these principles to the identification of possible systemic causes of accidents in anesthesia.     

A Teleonic Management Framework for Organizations

The hierarchical organization (HO) that has provided the prevailing model for business management for most of this century has been challenged repeatedly during the last 20 to 30 years. Matrix Management (MM), Total Quality Management (TQM), and Business Process Reengineering (BPR) are just three in the long line of approaches that have been suggested to remedy some of the problems with HO. Although these approaches have showed great promise, they either have been abandoned (MM), are on their way out (TQM), or are experiencing serious problems (BPR) in a large number of organizations that have tried to implement them. Yet many of these organizations have managed to make these approaches work. It is suggested in this paper that the main reasons for the failures do not lie in the models themselves, each of which have considerable merits, but in the absence of an overall theoretical framework, within which the various models could be validated and amalgamated. The authors are of the opinion that teleonics (proposed by Járos and Cloete, 1987) could serve as the basis for such a framework, which could thus be called the Teleonic Management Framework (TMF).