Rules, safety and the narrativisation of identity

A Hospital Operating Theatre Case Study

Dados Bibliográficos

ID2265746
AutoresRuth Mcdonald (0000-0002-3488-4209, University of Manchester, autor correspondente), J Waring (0000-0003-1459-5896, University of Nottingham), Stephen Harrison (0000-0001-5951-3300, University of Manchester)
Ano2006
Volume28
Fascículo2
Páginas178-202
Data de publicação2006-03-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoSociology of Health & Illness (JOURNAL)
Identificadores do periódicoISSN: 0141-9889 • E-ISSN: 1467-9566
EditoraWiley (PUBLISHER • GB)
DOI10.1111/j.1467-9566.2006.00487.x
PMID16509952
OpenAlexW2108914130
IdiomaEN
Citações recebidas30
Referências citadas50

Patient safety has become a health policy priority around the world. Acknowledging that 'to err is human' has led to attempts to design systems and rules that limit the capacity for individual discretion and thereby reduce clinical errors. In addition, great emphasis is being placed on the need to eradicate cultures of blame, which are assumed to discourage clinicians from reporting errors, and to establish a 'safety culture', which encourages openness and honesty. These efforts are underpinned by cognitive psychological explanations of the way individuals process information, which leads them to make errors of judgement. This paper examines the attitudes of hospital doctors and managers to the implementation of rules in the context of patient safety. Our analysis, using interpretive research focused on narrative identity, provides an alternative perspective to that offered by the current safety orthodoxy. This leads us to suggest that the achievement of a 'safety culture' is a remote prospect. The failure to follow formal written rules relates not to a deficiency in the cognitive capacity of individuals acting in isolation, but to the identities which individuals occupy, create and negotiate and the social rules (as opposed to clinical guidelines or protocols) which correspond to those identities

Blame · Context (archaeology) · Health care · Honesty · Identity (music) · Isolation (microbiology) · Narrative · Negotiation · Patient safety · Political science · Public relations · Sociology · Healthcare Quality and Management · Law · Medical Malpractice and Liability Issues · Occupational Health and Safety Research · Psychology · Social Psychology