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dc.contributor.authorDixon-Woods, Maryen
dc.contributor.authorTarrant, Cen
dc.contributor.authorBion, Jen
dc.contributor.authorLeslie, Men
dc.date.accessioned2018-02-19T08:08:44Z
dc.date.available2018-02-19T08:08:44Z
dc.date.issued2017-11-01en
dc.identifier.issn0277-9536
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/273319
dc.description.abstractMuch policy focus has been afforded to the role of “whistleblowers” in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 h of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), we studied how personnel gave voice to concerns about patient safety or poor practice. We observed much low-level social control occurring as part of day-to-day functioning on the wards, with challenges and sanctions routinely used in an effort to prevent or address mistakes and norm violations. Pre-emptions were used to intervene when patients were at immediate risk, and included strategies such as gentle reminders, use of humour, and sharp words. Corrective interventions included education and evidence-based arguments, while sanctions that were applied when it appeared that a breach of safety had occurred included “quiet words”, bantering, public exposure or humiliation, scoldings and brutal reprimands. These forms of social control generally functioned effectively to maintain safe practice. However, they were not consistently effective, and sometimes risked reinforcing norms and idiosyncratic behaviours that were not necessarily aligned with goals of patient safety and high-quality healthcare. Further, making challenges across professional boundaries or hierarchies was sometimes problematic. Our findings suggest that an emphasis on formal reporting or communication training as the solution to giving voice to safety concerns is simplistic; a more sophisticated understanding of social control is needed.
dc.description.sponsorshipThis study was funded by the Health Foundation, charity number 286967, and by Mary Dixon-Woods' Wellcome Trust Senior Investigator Award (WT097899).
dc.languageengen
dc.publisherElsevier
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectUnited Kingdomen
dc.subjectpatient safetyen
dc.subjectspeaking upen
dc.subjectintensive care unitsen
dc.subjectqualitative healthcare professionsen
dc.titleA qualitative study of speaking out about patient safety concerns in intensive care unitsen
dc.typeArticle
prism.endingPage15
prism.publicationDate2017en
prism.publicationNameSocial Science and Medicineen
prism.startingPage8
prism.volume193en
dc.identifier.doi10.17863/CAM.20344
dcterms.dateAccepted2017-09-20en
rioxxterms.versionofrecord10.1016/j.socscimed.2017.09.036en
rioxxterms.versionVoR*
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2017-11-01en
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
dc.identifier.eissn1873-5347
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idWellcome Trust (097899/Z/11/Z)
cam.issuedOnline2017-09-22en
cam.orpheus.successThu Jan 30 12:59:41 GMT 2020 - The item has an open VoR version.*
rioxxterms.freetoread.startdate2100-01-01


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International