Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety.
Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety.
复制标题
组织中的感染和互动仪式：临床医生在面对患者安全威胁时大声疾呼或保持沉默的描述。
DOI：
10.1111/1467-9566.12371
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发表时间：
2016
影响因子：
2.9
通讯作者：
Szymczak,JuliaE
中科院分区：
文献类型：
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作者：
Szymczak,JuliaE
临床医生在面对已知的对患者安全的威胁时保持沉默是一个越来越令人担忧的问题。目前对临床医生说话困难的解释是在个人或组织层面上概念化的，很少关注相互作用的背景。根据对美国一家医院的103名临床医生的采访，本文探讨了临床医生在面对感染预防技术的违规行为时如何谈论说出来。账户进行分析，使用微观社会学的透镜的互动故事，通过受访者呼吁医疗工作的情况和组织的现实，服务，以证明说话或保持沉默。分析这些帐户揭示了三种影响的决定说出来，在组织中的背景条件的形状;相互关注的焦点，interpretation路径依赖和观众的存在。这些研究结果表明，在临床环境中说话的决定是动态的，高度依赖于上下文，嵌入在日常工作中弥漫的互动仪式中，并受到组织动态的约束。这篇文章发展了一个更复杂和明显的社会学理解的原因，为什么说在医疗保健是如此困难。
Clinician silence in the face of known threats to patient safety is a source of growing concern. Current explanations for the difficulties clinicians have of speaking up are conceptualised at the individual or organisational level, with little attention paid to the space between – the interaction context. Drawing on 103 interviews with clinicians at one hospital in the United States this article examines how clinicians talk about speaking up or not in the face of breaches in infection prevention technique. Accounts are analysed using a microsociological lens as stories of interaction, through which respondents appeal to situational and organisational realities of medical work that serve to justify speaking up or remaining silent. Analysis of these accounts reveals three influences on the decision to speak up, shaped by background conditions in the organisation; mutual focus of attention, interactional path dependence and the presence of an audience. These findings suggest that the decision to speak up in a clinical setting is dynamic, highly context‐dependent, embedded in the interaction rituals that suffuse everyday work and constrained by organisational dynamics. This article develops a more sophisticated and distinctly sociological understanding of the reasons why speaking up in healthcare is so difficult.