Jurisdictional learning: When serious errors in healthcare trigger divergent responses in professional roles

Learning from serious errors in healthcare workplaces is crucial to prevent them from reoccurring. Typically, learning from errors implies convergence where healthcare professionals arrive at shared understanding and collaborate more closely. In this research, we study how doctors and nurses learn differently after they encountered the same serious errors. Drawing on three serious untoward incidents in an NHS Hospital Trust in England, we explain responses through "jurisdictional learning." We describe how errors prompt doctors and nurses to reinterpret their tasks, responsibilities, and authority from their existing jurisdictional positions. We find that doctors respond through jurisdictional encroachment, selectively extending oversight into tasks traditionally performed by nurses. Nurses, in contrast, respond through jurisdictional fortification where they reinforce their existing tasks and responsibilities through stronger reliance on policies, guidelines, and assertiveness. Our findings contrast the predominantly convergence-based logics of interprofessional learning by showing that professional roles interpret errors through the lens of their jurisdictional position and, in response, produce divergent role-based responses to redefine tasks, responsibilities, and authority.