Patient Safety as Carrot or Stick?

27 Apr

by Gavin Daker-White , Research Fellow in Multimorbidity theme

Junior Doctors Strike

In the patient safety literature, it is widely recognised that a team learning culture is crucial in reducing the incidence of errors or harms in health care settings. Thus, developing a “safety culture” lies at the heart of the NHS approach to improving patient safety, as exemplified by the National Reporting and Learning Service (NRLS). Drawing on other industries, including aviation, it has been shown that a, “blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment” is an important component of patient safety culture. However, it has also been shown that a blame culture persists, as evident in a recent literature review undertaken in our research centre.

Anyone who has been following the ongoing dispute between the British Medical Association (BMA) and the government over a proposed new employment contract for junior doctors will know that “patient safety” is a term that is regularly used to further arguments on both sides. The current Health Secretary, Jeremy Hunt, has argued that a 7-day NHS will improve patient safety. On the other side, the BMA argues that the proposed new contract will lead to junior doctors working unsafe hours. Over the last two days, media reports such as those here and here, have focused on what the effect on patient safety is of the industrial action itself. Again, a variety of views are discernible representing both sides in the dispute.

It is not the purpose of this piece to explain the nature of this industrial action; nor to take sides. As a patient safety researcher and sociologist, what interests me is the way that all sides seem to use “patient safety” as an explanation for policies or actions, or as an apparent stick with which to beat the other side. We know from clinically focused studies that “blame” is not helpful when attempting to promote learning cultures that can improve the safety of patients using health services. Whilst this might point to a potential to transfer notions of “safety culture” from the health service shop floor to policy making arenas,  what is more interesting to me is the way that the term “patient safety” seems to be forming a kind of trope in rhetoric around health policy and practice.

The term “Patient Safety” is increasingly a lens used to explain, evaluate and argue for or against issues in health care delivery. Where previous generations might have been concerned about survival rates, waiting times for appointments, or costs of care; the contemporary focus seems to be about degrees of safety. Even a cursory glance at the media surrounding the junior doctors’ dispute reveals a focus on patient safety, although it appears wedded to a ‘blame’ culture which is unlikely to work if the goal is to reduce the incidence of errors or harms.

Is this dispute really about patient safety?

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