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Sociol Health Illn. 2016 Feb;38(2):216-32. doi: 10.1111/1467-9566.12370. Epub 2015 Nov 4.

What is the role of individual accountability in patient safety? A multi-site ethnographic study.

Author information

1
Department of health Sciences, University of Leicester, UK.
2
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, USA.
3
Ethox Centre, University of Oxford, UK.

Abstract

An enduring debate concerns how responsibility for patient safety should be distributed between organisational systems and individual professionals. Though rule-based, calculus-like approaches intended to support a 'just culture' have become popular, they perpetuate an asocial and atomised account. In this article, we use insights from practice theory--which sees organisational phenomena as accomplished in everyday actions, with individual agency and structural conditions as a mutually constitutive, dynamic duality--along with contributions from the political science and ethics literature as a starting point for analysis. Presenting ethnographic data from five hospitals, three in one high-income country and two in low-income countries, we offer an empirically informed, normative rethinking of the role of personal accountability, identifying the collective nature of the healthcare enterprise and the extent to which patient safety depends on contributions from many hands. We show that moral responsibility for actions and behaviours is an irreducible element of professional practice, but that individuals are not somehow 'outside' and separate from 'systems': they create, modify and are subject to the social forces that are an inescapable feature of any organisational system; each element acts on the other. Our work illustrates starkly the structuring effects of the broader institutional and socioeconomic context on opportunities to 'be good'. These findings imply that one of the key responsibilities of organisations and wider institutions in relation to patient safety is the fostering of the conditions of moral community.

KEYWORDS:

ethnography; patient and public engagement; safety

PMID:
26537016
PMCID:
PMC4755229
DOI:
10.1111/1467-9566.12370
[Indexed for MEDLINE]
Free PMC Article
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