IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v69y2009i12p1722-1731.html
   My bibliography  Save this article

Constructing and re-constructing narratives of patient safety

Author

Listed:
  • Waring, Justin J.

Abstract

In the pursuit of enhanced patient safety, new forms of organisational learning have been introduced within healthcare services across the developed world. This paper examines how these systems contribute to the creation of knowledge about patient safety. The approach taken in this paper departs significantly from methods found within mainstream patient safety research. Rather than attempting to define clinical incidents through taxonomies or classifications, it considers how knowledge is socially constructed in clinical practice and through the processes of risk management. Specifically, it considers how narratives - the stories produced by staff in a large teaching hospital in the UK - about patient safety events are developed within the interactions of clinical practice, reflecting a dynamic mix of emotion and shared notions of responsibility. It then shows how these are re-produced as incident reports which transform knowledge through check-boxes and pre-defined categorisations leading to de-contextualised 'narrow narratives'. The paper then examines how these accounts are further re-produced through risk management activities as they become de-authored and re-constructed to reflect managerial assumptions about learning. Through considering how patient safety narratives emerge through these processes, the paper highlights the contribution that ethnographic research, with a particular focus on narrative construction, can make to the study of patient safety. It offers an alternative to the current orthodoxy of policy and raises questions about the capacity of such systems to shape the production of knowledge to the determinant of service improvement and to act as a mechanism of organisational power.

Suggested Citation

  • Waring, Justin J., 2009. "Constructing and re-constructing narratives of patient safety," Social Science & Medicine, Elsevier, vol. 69(12), pages 1722-1731, December.
  • Handle: RePEc:eee:socmed:v:69:y:2009:i:12:p:1722-1731
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00656-X
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Waring, Justin J., 2005. "Beyond blame: cultural barriers to medical incident reporting," Social Science & Medicine, Elsevier, vol. 60(9), pages 1927-1935, May.
    2. Ted To, 1999. "Risk and evolution," Economic Theory, Springer;Society for the Advancement of Economic Theory (SAET), vol. 13(2), pages 329-343.
    3. Iedema, Rick & Flabouris, Arthas & Grant, Susan & Jorm, Christine, 2006. "Narrativizing errors of care: Critical incident reporting in clinical practice," Social Science & Medicine, Elsevier, vol. 62(1), pages 134-144, January.
    4. ., 1999. "The assessment of country risk," Chapters, in: Handbook of Banking Regulation and Supervision in the United Kingdom, chapter 22, Edward Elgar Publishing.
    5. Gerardo Patriotta, 2003. "Sensemaking on the Shop Floor: Narratives of Knowledge in Organizations," Journal of Management Studies, Wiley Blackwell, vol. 40(2), pages 349-375, March.
    6. anonymous, 1999. "Models for valuing default-risky securities," Financial Update, Federal Reserve Bank of Atlanta, vol. 12(Jan), pages 1-3.
    7. Mizrahi, Terry, 1984. "Managing medical mistakes: Ideology, insularity and accountability among internists-in-training," Social Science & Medicine, Elsevier, vol. 19(2), pages 135-146, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Iedema, Rick, 2009. "New approaches to researching patient safety," Social Science & Medicine, Elsevier, vol. 69(12), pages 1701-1704, December.
    2. McGivern, Gerry & Fischer, Michael D., 2012. "Reactivity and reactions to regulatory transparency in medicine, psychotherapy and counselling," Social Science & Medicine, Elsevier, vol. 74(3), pages 289-296.
    3. Fischer, Michael Daniel & Ferlie, Ewan, 2013. "Resisting hybridisation between modes of clinical risk management: Contradiction, contest, and the production of intractable conflict," Accounting, Organizations and Society, Elsevier, vol. 38(1), pages 30-49.
    4. Nicolini, Davide & Waring, Justin & Mengis, Jeanne, 2011. "Policy and practice in the use of root cause analysis to investigate clinical adverse events: Mind the gap," Social Science & Medicine, Elsevier, vol. 73(2), pages 217-225, July.
    5. Ducey, Ariel & Donoso, Claudia & Ross, Sue & Robert, Magali, 2020. "From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh," Social Science & Medicine, Elsevier, vol. 260(C).
    6. Spendlove, Zoey, 2018. "Medical revalidation as professional regulatory reform: Challenging the power of enforceable trust in the United Kingdom," Social Science & Medicine, Elsevier, vol. 205(C), pages 64-71.
    7. Turner, Simon & Higginson, Juliet & Oborne, C. Alice & Thomas, Rebecca E. & Ramsay, Angus I.G. & Fulop, Naomi J., 2014. "Codifying knowledge to improve patient safety: A qualitative study of practice-based interventions," Social Science & Medicine, Elsevier, vol. 113(C), pages 169-176.
    8. Martin, Graham P. & Chew, Sarah & Dixon-Woods, Mary, 2021. "Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study," Social Science & Medicine, Elsevier, vol. 287(C).
    9. Martin, Graham P. & McKee, Lorna & Dixon-Woods, Mary, 2015. "Beyond metrics? Utilizing ‘soft intelligence’ for healthcare quality and safety," Social Science & Medicine, Elsevier, vol. 142(C), pages 19-26.
    10. Doherty, Carole & Saunders, Mark N.K., 2013. "Elective surgical patients' narratives of hospitalization: The co-construction of safety," Social Science & Medicine, Elsevier, vol. 98(C), pages 29-36.
    11. Szymczak, Julia E., 2014. "Seeing risk and allocating responsibility: Talk of culture and its consequences on the work of patient safety," Social Science & Medicine, Elsevier, vol. 120(C), pages 252-259.
    12. Ovretveit, John, 2009. "The contribution of new social science research to patient safety," Social Science & Medicine, Elsevier, vol. 69(12), pages 1780-1783, December.
    13. Maras, Shelly A., 2023. "“You just want to feel safe when you go to a healthcare professional:” Intimate partner violence and patient safety," Social Science & Medicine, Elsevier, vol. 331(C).
    14. Ferlie, Ewan & Mcgivern, Gerry & FitzGerald, Louise, 2012. "A new mode of organizing in health care? Governmentality and managed networks in cancer services in England," Social Science & Medicine, Elsevier, vol. 74(3), pages 340-347.
    15. Litorp, Helena & Mgaya, Andrew & Mbekenga, Columba K. & Kidanto, Hussein L. & Johnsdotter, Sara & Essén, Birgitta, 2015. "Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting," Social Science & Medicine, Elsevier, vol. 143(C), pages 232-240.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Tovey, P. & Broom, Alex, 2007. "Oncologists' and specialist cancer nurses' approaches to complementary and alternative medicine and their impact on patient action," Social Science & Medicine, Elsevier, vol. 64(12), pages 2550-2564, June.
    2. Campbell, Patricia, 2011. "Boundaries and risk: Media framing of assisted reproductive technologies and older mothers," Social Science & Medicine, Elsevier, vol. 72(2), pages 265-272, January.
    3. Miller, Tina & Boulton, Mary, 2007. "Changing constructions of informed consent: Qualitative research and complex social worlds," Social Science & Medicine, Elsevier, vol. 65(11), pages 2199-2211, December.
    4. Washer, Peter & Joffe, Helene, 2006. "The "hospital superbug": Social representations of MRSA," Social Science & Medicine, Elsevier, vol. 63(8), pages 2141-2152, October.
    5. Abel, Gillian M., 2011. "Different stage, different performance: The protective strategy of role play on emotional health in sex work," Social Science & Medicine, Elsevier, vol. 72(7), pages 1177-1184, April.
    6. Shaw, Alison, 2011. "Risk and reproductive decisions: British Pakistani couples' responses to genetic counselling," Social Science & Medicine, Elsevier, vol. 73(1), pages 111-120, July.
    7. Griffiths, F. & Green, E. & Bendelow, G., 2006. "Health professionals, their medical interventions and uncertainty: A study focusing on women at midlife," Social Science & Medicine, Elsevier, vol. 62(5), pages 1078-1090, March.
    8. Curtis Breslin, F. & Polzer, Jessica & MacEachen, Ellen & Morrongiello, Barbara & Shannon, Harry, 2007. "Workplace injury or "part of the job"?: Towards a gendered understanding of injuries and complaints among young workers," Social Science & Medicine, Elsevier, vol. 64(4), pages 782-793, February.
    9. Samsonova-Taddei, Anna & Humphrey, Christopher, 2015. "Risk and the construction of a European audit policy agenda: The case of auditor liability," Accounting, Organizations and Society, Elsevier, vol. 41(C), pages 55-72.
    10. Pound, Pandora & Campbell, Rona, 2015. "Exploring the feasibility of theory synthesis: A worked example in the field of health related risk-taking," Social Science & Medicine, Elsevier, vol. 124(C), pages 57-65.
    11. Kerr, Anne, 2009. "A problem shared...? Teamwork, autonomy and error in assisted conception," Social Science & Medicine, Elsevier, vol. 69(12), pages 1741-1749, December.
    12. Barratt, Helen & Harrison, David A. & Raine, Rosalind & Fulop, Naomi J., 2015. "Factors that influence the way local communities respond to consultation processes about major service change: A qualitative study," Health Policy, Elsevier, vol. 119(9), pages 1210-1217.
    13. Turner, Simon & Higginson, Juliet & Oborne, C. Alice & Thomas, Rebecca E. & Ramsay, Angus I.G. & Fulop, Naomi J., 2014. "Codifying knowledge to improve patient safety: A qualitative study of practice-based interventions," Social Science & Medicine, Elsevier, vol. 113(C), pages 169-176.
    14. Keddell, Emily, 2014. "Theorising the signs of safety approach to child protection social work: Positioning, codes and power," Children and Youth Services Review, Elsevier, vol. 47(P1), pages 70-77.
    15. Kendall, Kathleen & Wiles, Rose, 2010. "Resisting blame and managing emotion in general practice: The case of patient suicide," Social Science & Medicine, Elsevier, vol. 70(11), pages 1714-1720, June.
    16. Miguel Pina E Cunha, 2007. "Entrepreneurship As Decision Making: Rational, Intuitive And Improvisational Approaches," Journal of Enterprising Culture (JEC), World Scientific Publishing Co. Pte. Ltd., vol. 15(01), pages 1-20.
    17. Fischer, Michael Daniel & Ferlie, Ewan, 2013. "Resisting hybridisation between modes of clinical risk management: Contradiction, contest, and the production of intractable conflict," Accounting, Organizations and Society, Elsevier, vol. 38(1), pages 30-49.
    18. Fu-Sheng Tsai & Gayle Baugh & Shih-Chieh Fang & Julia Lin, 2014. "Contingent contingency: Knowledge heterogeneity and new product development performance revisited," Asia Pacific Journal of Management, Springer, vol. 31(1), pages 149-169, March.
    19. Li, Shenxue & Clark, Timothy & Sillince, John, 2018. "Constructing a strategy on the creation of core competencies for African companies," Technological Forecasting and Social Change, Elsevier, vol. 131(C), pages 204-213.
    20. Suzanne Scotchmer, 2003. "Affirmative Action in Hierarchies," Industrial Organization 0303005, University Library of Munich, Germany.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:69:y:2009:i:12:p:1722-1731. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.