Constructing and re-constructing narratives of patient safety

Area of Science:

• Healthcare Management
• Sociology of Health
• Patient Safety Research

Background:

• New organizational learning systems are implemented in healthcare globally to improve patient safety.
• Existing patient safety research often relies on taxonomies and classifications for incident analysis.

Purpose of the Study:

• To examine how organizational learning systems shape knowledge creation regarding patient safety.
• To investigate the social construction of patient safety knowledge within clinical practice and risk management.
• To offer an alternative perspective to mainstream patient safety research through an ethnographic lens.

Main Methods:

• Qualitative analysis of narratives about patient safety events from healthcare staff.
• Examination of how these narratives are transformed into formal incident reports.
• Analysis of how risk management processes further re-construct these accounts.
• Ethnographic research focusing on narrative construction in a UK teaching hospital.

Main Results:

• Patient safety narratives are socially constructed through clinical interactions, involving emotions and shared responsibility.
• Incident reports de-contextualize knowledge using pre-defined categories, creating 'narrow narratives'.
• Risk management activities further alter these accounts, reflecting managerial assumptions and potentially diminishing their original context.
• Formal systems may inadvertently limit the depth of organizational learning about patient safety.

Conclusions:

• Ethnographic research focusing on narrative construction offers valuable insights into patient safety.
• Current patient safety systems may transform rich narratives into de-contextualized data, potentially impacting service improvement.
• The study questions the effectiveness of existing systems in fostering true organizational learning and highlights their potential as mechanisms of organizational power.