Abstract
It is a key assumption within mainstream patient safety literature that healthcare is dominated by a culture of blame. To test this claim, Pedersen presents empirical studies on medical training, internal error regulation and clinical safety culture by medical sociologists Rene Fox, Charles Bosk, Marianne Paget and Marilynn Rosenthal. Here, the image of a person-centred and blame-inducing clinical culture is fundamentally contested. Rather, the analysis reveals a delicate ecology of co-collegial observation, classification and management of different sorts of errors, mistakes and misconduct, where the uncertain, time-dependent and fallible character of medical knowledge has such an effect that incompetence and malpractice are sometimes hard to identify. By rearticulating these traditional modes of error management within the professional community, Pedersen challenges current blame-free strategies of safety management.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
These earlier studies all investigate the medical communities from within. They do not deal with the public or political view of medical culture, which might at times well be dominated by an attitude of ‘naming, blaming and shaming’. Also, they do not deal with the problem of rising liability suits and malpractice claims.
- 2.
That medicine has a problematic relationship with probability per se can easily be contested. As Foucault argues in The Birth of the Clinic (1994/1963), the collection of sick into clinical hospitals in the late eighteenth century became the start of the development of medical statistics. Disease also came to be viewed epidemiologically—as the distribution of morbidity in a population, and in terms of the statistical likelihood of becoming ill, being cured, dying, and so on.
- 3.
While Rosenthal’s analyses are predominantly based on British material, she shortly refers to a Swedish case. In the Swedish case, she concludes that ‘there is even greater reluctance to criticize, not only because of cultural norms that discourage public criticism of anyone. Problem doctors are a “forbidden” subject, a subject of shame that one of their numbers should be causing problems or found to be incompetent’ (Rosenthal 1995: 106). She further suggests that the ‘export’ problem where a problem doctor is exported to somewhere else in the healthcare system is more evident in Sweden, where jobs are changed more frequently.
- 4.
Is not entirely clear what Rosenthal means when she speaks about formality and informality. Obviously, that something is internal, and behind closed doors, does not exempt it from being formalized. Most often, however, it seems that Rosenthal is not talking about the degree of formalization but rather the degree of ‘closedness’: When measures are taken by and of professionals only, she describes them as informal. When they include management, they are quasi-formal. And when they are public, they are formal.
- 5.
In the Danish legal system, questions of impairment and negligence are regulated in Law of Authorization (LBK no. 877), in which §6 establishes that Danish Health Authority can withdraw authorization because of physical or mental illness or drug/alcohol addiction while §7 on negligence concerns instances of serious or repeated ‘criticizable professional conduct’.
- 6.
Personal comment, September 18, 2012, internal seminar at Department of Organization, Copenhagen Business School.
References
Atkinson, P. A. (1984). Training for certainty. Social Science and Medicine, 19, 949–956.
Bosk, C. L. (1979/2003). Forgive and remember: Managing medical failure (2nd ed.). Chicago: The University of Chicago Press.
Brennan, T. A., Leape, L. L., Laird, N., et al. (1991). Incidence of adverse events and negligence in hospitalized patients: Results from the Harvard Medical Practice Study I. New England Journal of Medicine, 324, 370–376.
Cassell, J. (2002). Social scientists studying doctors: 1951 to 2001. Reviews in Anthropology, 31(3), 243–262.
Collins, M. E., Block, S. D., Arnold, R. M., & Christakis, N. A. (2009). On the prospects for a blame-free medical culture. Social Science and Medicine, 69(9), 1287–1290.
Department of Health. (2000). An organisation with a memory: Expert group report. London: Department of Health.
Foucault, M. (1994). The birth of the clinic: An archaeology of medical perception. French edn 1963, English edn 1973. New York: Vintage Books.
Fox, R. (1957). Training for uncertainty. In R. K. Merton, G. Reader, & P. L. Kendall (Eds.), The student-physician: Introductory studies in the sociology of medical education (pp. 207–241). Cambridge, MA: Harvard University Press.
Fox, R. (1959). Experiment perilous: Physicians and patients facing the unknown. New Brunswick, NJ: Transaction Publishers.
Fox, R. C. (1980). The evolution of medical uncertainty. The Milbank Memorial Fund Quarterly. Health and Society, 58(1), 1–49.
Fox, R. C. (2000). Medical uncertainty revisited. In G. L. Albrecht, R. Fitzpatrick, & S. C. Scrimshaw (Eds.), The handbook of social studies in health and medicine (pp. 409–427). London: Sage Publications.
Fox, R. C., & Swazey, J. (1974). The courage to fail: A social view of organ transplants and dialysis. Chicago: University of Chicago Press.
Freidson, E. (1975). Doctoring together: A study of professional social control. Chicago: University of Chicago Press.
Freidson, E. (2001). Professionalism, the third logic: On the practice of knowledge. Chicago: The University of Chicago Press.
Gorovitz, S., & MacIntyre, A. (1976). Toward a theory of medical fallibility. Journal of Medicine and Philosophy, 1(1), 51–53.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Committee on Quality of Healthcare in America, Institute of Medicine. Washington, DC: National Academy Press.
Leape, L. L., Brennan, T. A., Laird, N., et al. (1991). The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 324(6), 377–384.
Leape, L. L., Woods, D. D., Hatlie, M. J., et al. (1998). Promoting patient safety by preventing medical error. JAMA, 280(16), 1444–1447.
Paget, M. (1988). The unity of mistake: A phenomenological interpretation of medical work. Philadelphia: Temple University Press.
Perrow, C. (1984). Normal accidents: Living with high-risk technologies. Princeton, NJ: Princeton University Press.
Reason, J. (1990). Human error. Cambridge: Cambridge University Press.
Reason, J. (2000). Human error: Models and management. BMJ, 320, 768–770.
Rosenthal, M. M. (1995). The incompetent doctor: Behind closed doors. Philadelphia: Open University Press.
Timmermans, S., & Angell, A. (2001). Evidence-based medicine, clinical uncertainty, and learning to doctor. Journal of Health and Social Behavior, 42(4), 342–359.
Wachter, R. M., & Pronovost, P. J. (2009). Balancing no-blame with accountability in patient safety. New England Journal of Medicine, 361, 1401–1406.
Waring, J. (2007). Doctors’ thinking about ‘the system’ as a threat to patient safety. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 11(1), 29–46.
WHO. (2011). Multi-professional patient safety curriculum guide. Geneva, Switzerland: World Health Organization.
Woodward, H., Lemer, C., & Wu, A. (2009). An end to the witch hunts: Responding to the defenders of blame and shame: A commentary on Collins, Block, Arnold and Christakis. Social Science and Medicine, 69(9), 1291–1293.
Author information
Authors and Affiliations
Copyright information
© 2018 The Author(s)
About this chapter
Cite this chapter
Pedersen, K.Z. (2018). Blame and Responsibility in Patient Safety. In: Organizing Patient Safety. Health, Technology and Society. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-53786-7_4
Download citation
DOI: https://doi.org/10.1057/978-1-137-53786-7_4
Published:
Publisher Name: Palgrave Macmillan, London
Print ISBN: 978-1-137-53785-0
Online ISBN: 978-1-137-53786-7
eBook Packages: Social SciencesSocial Sciences (R0)