Elsevier

Social Science & Medicine

Volume 69, Issue 12, December 2009, Pages 1780-1783
Social Science & Medicine

The contribution of new social science research to patient safety

https://doi.org/10.1016/j.socscimed.2009.09.053Get rights and content

Abstract

Social sciences have given much to the science and practice of patient safety, but have more to offer. The purposes of this paper are to give a background to the studies presented in this special issue, and to encourage more social scientist to contribute to this important and rapidly growing field. This is largely preaching to the converted - there is one other purpose which may be achieved if more traditional medical researchers and reviewers see this special issue. That is to show how social sciences help to understand, explain and address many issues which traditional medical research methods are not designed to penetrate. This special issue shows the value of social science patient safety research, and gives a reference point for future researchers in making proposals, designing research and comparing their findings. It highlights areas which this research needs to address in its methods, presentation, and subjects studied.

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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