In our view, patient safety can only ‘happen’ when it  exists in the minds of those at the point of delivering care: managers, clinicians, patients and carers. Thus part of our work is to explore how risk and safety are understood at this ‘low level’ organisational space  and how to help those responsible for constructing safe care for patients do so effectively.

Background 

Industrial safety systems thinking has recently been promoted widely in healthcare as a means of improving the safety of care (Kohn et al. 1999).  This reflects the increasing pressure from healthcare professionals and service users alike for higher quality care and the avoidance of unnecessary risk.  However, there are important differences between the two settings. In particular, healthcare staff may be more likely to see themselves as belonging to a particular professional group than as ‘equivalent actors’ within a safety system (Amalberti 2005). Key to this is the notion of personal identity. The formation, understanding and expression of identity (Brown, 1986).and the part played in this by our relations to others (Markus & Kitayama, 1991,Hatch & Schultz, 2004) are central themes in social psychology. There is, however, very little work on professional identity in healthcare workers either in general or specifically on the relationship between identity and notions of risk and safety. Identity influences an individual’s understanding of his/her (professional) environment, including the notions of risk and safety (Lupton, 1999). As McDonald et al (2005) argue  

‘individuals perceive and interpret risk in the context of their place in a society whose particular social forms influence what they come to perceive as risks. The implication of this approach is that challenges to risk perception represent not an appeal to individuals to adopt an alternative cognitive perspective, but a threat to existing forms of social order and, by implication, the shared values and beliefs which underpin those.’ (pp 399-400) 

Personality, culture and professional identity, and how they relate to risk and safety is at the centre of our scrutiny. Most work has been in the operating theatre setting, (McDonald et all 2005). In handover communication between anaesthetists and nurses in the postoperative recovery room (Smith et al 2007) there were informally-negotiated practices which demonstrated different and sometimes conflicting conceptions of what each professional groups considered as within the boundaries of safe practice. In MacDonald’s work, standardisation and the use of protocols in the name of promoting safety appeared to bolster managerial identities and seemed to be a key component of professional identity in nursing. In contrast, such developments appeared to threaten the medical identity. However, how these attitudes come about, how they are conceptualised within individual professional identities and what consequences they might have, have not been explored.

Aims and objectives 

This project focuses on the relationship between identity and risk in more detail in a number of contrasting groups of staff in acute care settings. Our specific research questions are:  

1  To what extent are notions of risk and safety part of the way healthcare practitioners are thinking in order to guide their day-to-day work? How are these ways of thinking learned and/or adopted?

2  If patient safety  is not included in these ways of thinking mentioned above, what is their relation to potentially conflicting aims of one’s daily routine – for instance, how do they relate to patient comfort, quality of care, efficiency, patient autonomy etc?

3  If  we assume that some practitioners are more tuned to safety problems within their work routines than others, could professional status and/or training account for such a phenomenon?

4 Are there benefits and rewards to having a higher sensitivity to risk and safety in the workplace, and if so what are they?  

Relevant literature 

Amalberti R, Auroy Y,  Barach P, Berwick DM. Five system barriers to achieving ultrasafe health care. Annals of Internal Medicine 2005; 142: 756-64. 

Brown, R. (c1986) Social psychology, second edition, New York: Free Press; London:Collier Macmillan 

Glaser, B. G. & Strauss, A. (1967) The Discovery of Grounded Theory: Strategies forQualitative Research. Chicago, IL: Aldine Publishing Co. 

Hatch, M. J. and Schultz, M. (2003) Bringing the corporation into corporatebranding, European Journal of Marketing, 37 (7/8), p. 1041-1064 

Kohn L, Corrigan J, Donaldson ME (1999) ‘To er is human’ National Academy Press, Washington, DC 

Leape LL (1994) Error in Medicine. Journal of the American Medical Association 272: 1851-1857 

Lupton, D. (1999) Risk New York: Routledge 

Markus, H. and Kitayama, S. (1991) Culture and the self: implications for cognition, emotion and motivation, Psychological review, 98, p. 224-253 

McDonald R, Waring J, Harrison S. (2005) ‘Balancing risk, that is my life’: The politics of risk in a hospital operating theatre department. Health Risk & Society 7:4, 397 

McDonald R,  Waring J,  Harrison S, Boaden R, Walshe K, Parker D. (2005) An Ethnographic Study of Threats to Patient Safety in the Operating Theatre.  Available at: http://www.pcpoh.bham.ac.uk/publichealth/psrp/Pdf/Harrison_Final_Final_Report_Dec_2005.pdf  

Smith AF, Pope C, Goodwin D, Mort M.’ Contested conversations’: an observational study of patient handovers in the recovery room. Acta Anaesthesiologica Scandinavica 2007; 51(Suppl 118): 18-19 

Triandis, H.C., Bontempo, R., Villareal, M., Asai, M. and Lucca, N. (1988) Individualism and collectivism: cross cultural perspectives on self-in-grouprelationships, Journal of personality and Social Psychology, 54 (2), p. 323-338 

Wilson J, Woods I, Fawcett J et al (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. British  Med J 318: 1099–103