Risky behaviour and patient safety: a critical culturist perspective

This paper aims to utilise cultural theory of risk to provide a broad analytic framework for examining how risk is constructed within the dominant discourses around patient safety within the domain of psychiatry. It also seeks to examine notions of blame and to consider the possibility of the creation of a no-blame culture.

The empirical element of the paper draws on qualitative interviews with a sample of psychiatrists to explore how culture may give rise to different perceptions and responses in respect of "risky behaviour" and "safe practice".

The paper discusses how psychiatry may be differentiated from other branches of medicine and concludes that the cultural grouping that appears to be most apposite in respect of psychiatrists is the egalitarian culture. However, changes in the NHS are resulting in the imposition of an individualistic culture on the community of psychiatrists with the effect that behaviours are being adopted as measures to avoid potential blame.

The paper finds that if the NHS is to improve patient safety then it must recognise that it is not possible to create a no-blame culture and, therefore, it is more important to consider which type of culture will impact most positively on patient safety. It appears that psychiatrists are being compelled to adopt an individualistic culture when an egalitarian culture would be more advantageous for patient safety.

In contrast with the methodological individualism of the current safety orthodoxy which interprets risk as an objective and measurable phenomenon, the paper draws on cultural theory of risk to develop a critical perspective on current safety policy and to explore how "risky" and "safe" practices are socially constructed in the context of psychiatry.