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A problem shared...? Teamwork, autonomy and error in assisted conception

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  • Kerr, Anne

Abstract

This paper explores the benefits and drawbacks of new team-based approaches to error management in medicine through a case study of teamwork, double witnessing and incident reporting in assisted conception clinics in the UK. This is based upon the analysis of a series of semi-structured interviews with people working in assisted conception clinics and two periods of ethnography in clinics, conducted between 2004 and 2007, as part of an ESRC-funded study on the ethics of assisted conception and embryo research. In common with other studies of practitioners' management of error, I identify a series of tensions around individual and collective autonomy in identifying and preventing error, for the assisted conception team as a whole, and for particular groups within it, notably consultants and embryologists. I found that team-based approaches could create the conditions for error to occur when it undermined independent thinking, responsibility or concentration. There was also a danger that teamwork could come to be associated with particular 'technical' practices or occupational groups, diminishing its relevance and value in clinical settings. I, therefore, conclude that team-based approaches and professional autonomy have their 'dark' as well as their 'light' sides (Vaughan, D. (1999). The dark side of organisations: mistake, misconduct, and disaster. Annual Review of Sociology, 25, 271-305). Errors cannot be prevented in their entirety, but they can be well managed when teamwork and autonomy are complementary. Drawing on Reason (Reason, J. (2004). Beyond the organisational accident: the need for "error wisdom" on the frontline. Quality Safety in Health Care, 12, ii28-ii33), I argue that informed vigilance and intelligent wariness in a necessary compliment to systems-based approaches to error management in assisted conception in particular, and medicine in general.

Suggested Citation

  • Kerr, Anne, 2009. "A problem shared...? Teamwork, autonomy and error in assisted conception," Social Science & Medicine, Elsevier, vol. 69(12), pages 1741-1749, December.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:12:p:1741-1749
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    References listed on IDEAS

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    1. 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.
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    3. Rodriquez, Jason, 2015. "Who is on the medical team?: Shifting the boundaries of belonging on the ICU," Social Science & Medicine, Elsevier, vol. 144(C), pages 112-118.

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