The contribution of new social science research to patient safety
Introduction
I make my comments on the fascinating collection of papers in this Special Issue as a social scientist working in the Karolinska Institutet, one of the “cathedrals” of medical science in Northern Europe, and as researcher into quality and safety in health care since the early 1980s. I'd like to start by saying that what people say, do and feel are facts. People live and work in groups, in a society and are influenced by this “context”. People do not do what they are told to do for many different reasons. We can make more progress in understanding why adverse events do and do not occur, and how to prevent them if we know more about these aspects of patient safety. These are some of the messages of the studies reported in this special issue of Social Science & Medicine. Encouragingly, they are also points increasingly recognised by decision makers and “implementers” frustrated by the challenges of changing healthcare.
Why do nurses who know their patient is deteriorating not call the medical emergency team when they have been told this is what they should do? Why are doctors reluctant to report “near misses” or to carry out “open disclosure” when this is the agreed policy? How do adverse events affect doctors and nurses? These are questions which urgently need to be answered if ways of improving safety are to be discovered and put into practice beyond a few pilot examples (Øvretveit, 2005).
Innovative social science theories and methods may help us address these questions, but they tend to be marginalised in a field where “number-knowledge” dominates. This special issue shows the value of this type of research, and gives a reference point for future researchers in making proposals, designing research and comparing their findings.
This commentary provides a summary of some of the practical and research issues raised by these studies and the potential future contribution to safety science of recent qualitative and reflexive social science research.
Section snippets
Issues raised by the current collection of papers
Often the practical contribution of the social sciences has been in ways of thinking about social problems and providing frameworks for analysis, rather than a “to-do” “evidence based” “checklist” for decision makers (Black, 2001). The social sciences are increasingly viewed by policy-makers and implementers as a resource for helping with the considerable challenges they have encountered in “implementing” changes which are thought to be necessary to improve safety and quality. Research bodies
Methodological and practical issues raised by the studies
This part of my commentary highlights and explores some of the research and practical issues raised by the papers presented in this special issue. It draws attention to how social science research can make a contribution to the newly emerging “science of patient safety”, and how social sciences can also shape the nature of such a science towards a more multidisciplinary and perhaps “multi-paradigm science”, if the latter is not a contradiction in terms. A key issue is how to ensure room for
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Cited by (28)
Who is on the medical team?: Shifting the boundaries of belonging on the ICU
2015, Social Science and MedicineCitation Excerpt :A recent literature review found that out of more than 500 published studies of ICU interprofessional care delivery, only 24 utilized ethnographic methods and only six of those were based on data from the United States (Paradis et al., 2014). Qualitative methods are particularly advantageous for understanding social processes that shape medical care (Charmaz and Olesen, 1997; Dixon-Woods et al., 2012; Dixon-Woods and Bosk, 2010; Ovretveit, 2009). Qualitative social science shows how cultural and organizational contexts are deeply implicated in medical teamwork.
Organizational and social-psychological conditions in healthcare and their importance for patient and staff safety: A critical incident study among doctors and nurses
2014, Safety ScienceCitation Excerpt :Interventions to improve patient and occupational safety in health care have, to date, largely focused on improving and enforcing routines and introducing new equipment. However, in order to be successful, such interventions need to better consider social and organizational contextual factors (Ovretveit, 2009). Systems for formal responsibility enforced by authorities and pointing towards the individual is another common approach.
Conferences, tablecloths and cupboards: How to understand the situatedness of quality improvements in long-term care
2013, Social Science and MedicineCitation Excerpt :A better understanding of the processes and content of quality improvements is necessary because of the still limited theoretical and empirical grounds underlying the approach of QIC's; theory driven and qualitative ‘process based’ research is particularly lacking (Dixon-Woods, Bosk, Aveling, Goeschel, & Pronovost, 2011; Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004; Mittman, 2004; Øvretveit, 2009; Schouten, Hulscher, Huijsman, & Grol, 2008; Walshe 2009). In-depth knowledge and descriptions of actual interventions and ongoing processes within such programs are important (Dixon-Woods et al. 2011; Greenhalgh, Russell, Ashcroft, & Parsons, 2011; Øvretveit, 2009; Øvretveit et al., 2002; Walshe & Freeman, 2002) and alternative conceptualization could help to redefine practices of quality improvement (Zuiderent-Jerak, Strating, Nieboer, & Bal, 2009). To achieve additional, deeper, more detailed (Greenhalgh et al., 2004, 2011) and richer (Mol, 2010) understanding of how change occurs and can be sustained, it is necessary to enter the situation where change is taking place.
Patients' willingness and ability to participate actively in the reduction of clinical errors: A systematic literature review
2012, Social Science and MedicineResisting blame and managing emotion in general practice: The case of patient suicide
2010, Social Science and MedicineCitation Excerpt :The implications of subsequent developments since these data were collected are considered in the discussion. This study addresses the general need for empirical work on individuals who have experienced auditing as identified by Power (2003, 2000) as well as a specific need for research on how emotions and feelings impact upon patient safety as identified by Ovretveit (2009). The study from which data used in this paper are drawn comprised case-study observation of CIRs in primary care; qualitative interviews with relatives of the deceased person and with primary health care team members who took part in reviews and audit; and documentary analysis of cases and changes that took place in practice as a result of the review (King et al., 2005).