A qualitative study of speaking out about patient safety concerns in intensive care units

Dados Bibliográficos

ID4845495
AutoresCarolyn Tarrant (0000-0001-7356-5342, University of Leicester), Michael Leslie (0000-0001-5759-7993, University of Calgary), Myles Leslie, Julian Bion (0000-0003-0344-5403, University of Birmingham), Mary Dixon-Woods (0000-0002-5915-0041, University of Cambridge, autor correspondente)
Ano2017
Volume193
Páginas8-15
Data de publicação2017-11-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoSocial Science & Medicine (JOURNAL)
Identificadores do periódicoISSN: 0277-9536 • E-ISSN: 1873-5347
EditoraElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2017.09.036
PMID28987982
OpenAlexW2758239729
IdiomaEN
Citações recebidas6
Referências citadas34

Much policy focus has been afforded to the role of "whistleblowers" in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 h of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), we studied how personnel gave voice to concerns about patient safety or poor practice. We observed much low-level social control occurring as part of day-to-day functioning on the wards, with challenges and sanctions routinely used in an effort to prevent or address mistakes and norm violations. Pre-emptions were used to intervene when patients were at immediate risk, and included strategies such as gentle reminders, use of humour, and sharp words. Corrective interventions included education and evidence-based arguments, while sanctions that were applied when it appeared that a breach of safety had occurred included "quiet words", bantering, public exposure or humiliation, scoldings and brutal reprimands. These forms of social control generally functioned effectively to maintain safe practice. But they were not consistently effective, and sometimes risked reinforcing norms and idiosyncratic behaviours that were not necessarily aligned with goals of patient safety and high-quality healthcare. Further, making challenges across professional boundaries or hierarchies was sometimes problematic. Our findings suggest that an emphasis on formal reporting or communication training as the solution to giving voice to safety concerns is simplistic; a more sophisticated understanding of social control is needed

Covert · Enforcement · Focus group · Health care · Humiliation · Intensive care · Patient safety · Political science · Psychological intervention · Public relations · Qualitative research · Sanctions · Sociology · Ethics in Business and Education · Ethics in medical practice · Law · Medicine · Nursing · Psychology · Social Psychology · Workplace Violence and Bullying