An ethnographic study of classifying and accounting for risk at the sharp end of medical wards
An ethnographic study of classifying and accounting for risk at the sharp end of medical wards
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DOI：
10.1016/j.socscimed.2009.05.025
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发表时间：
2009-08-01
影响因子：
5.4
通讯作者：
Tarrant, Carolyn
中科院分区：
文献类型：
--
作者：
Dixon-Woods, Mary;Suokas, Anu;Tarrant, Carolyn
了解工作人员如何识别、分类、叙述和定位患者安全风险，对于了解对实现变革的努力的反应非常重要。我们报告了一项民族志研究，在英国的四个医疗病房，在医院参加了健康基金会的更安全的病人倡议，一个组织范围内的病人安全计划。对观察结果和49次工作人员访谈的数据分析是根据经常比较法进行的。我们发现，工作人员经常参与确定什么可以算作风险，如何正确管理这些风险，以及如何解释他们的行为的实践。工作人员的做法和推理的风险出现通过他们的实际参与的日常工作的病房，但也塑造了社会的当务之急。在我们研究的环境中，风险不仅仅是对患者安全的风险;当事情出错时，专业身份也会受到威胁。工作人员在忙碌和复杂的病房环境中，以风险为导向，这影响了他们如何应对风险。关于风险的推理受到以下因素的影响：对护理患者时应促进哪些价值观的判断、社会规范、风险传播逻辑以及对特定行为和行动与结果相关联且应受指责的程度的看法。这些识别、评估和应对风险的方法可能对工作人员应对变革的努力产生很大影响，并突出了设计和实施患者安全干预措施的挑战。(C)2009爱思唯尔有限公司保留所有权利。
An understanding of how staff identify, classify, narrativise and orient to patient safety risks is important in understanding responses to efforts to effectchange. We report an ethnographic study of four medical wards in the UK, in hospitals that were participating in the Health Foundation's Safer Patients Initiative, an organisation-wide patient safety programme. Data analysis of observations and 49 interviews with staff was based on the constant comparative method. We found that staff engaged routinely in practices of determining what gets to count as a risk, how such risks should properly be managed, and how to account for what they do. Staff practices and reasoning in relation to risk emerged through their practical engagement in the everyday work of the wards, but were also shaped by social imperatives. Risks, in the environment we studied, were not simply risks to patient safety; when things went wrong, professional identity was at risk too. Staff oriented to risks in the context of busy and complex ward environments, which influenced how they accounted for risk. Reasoning about risk was influenced by judgements about which values should be promoted when caring for patients, by social norms, by risk-spreading logics, and by perceptions of the extent to which particular behaviours and actions were coupled to outcomes and were blameworthy. These ways of identifying, evaluating and addressing risks are likely to be highly influential in staff responses to efforts to effect change, and highlight the challenges in designing and implementing patient safety interventions. (C) 2009 Elsevier Ltd. All rights reserved.