The role of professional communities in governing patient safety

Using the example of medication safety, this paper aims to explore the impact of three managerial interventions (adverse incident reporting, ward-level support by pharmacists, and a medication safety subcommittee) on different professional communities situated in the English National Health Service (NHS).

Semi-structured interviews were conducted with clinical and managerial staff from two English NHS acute trusts, supplemented with meeting observations and documentary analysis.

Attitudes toward managerial intervention differ by professional community (between doctors, nurses and pharmacists) according to their existing norms of safety and perceptions of formal governance processes.

The heterogeneity of social norms across different professional communities and medical specialties has implications for the design of organisational learning mechanisms in the field of patient safety.

The paper shows that theorisation of professional "resistance" to managerialism privileges the study of doctors' reactions to management with the consequent neglect of the perceptions of other professional communities.