Patient Safety: Whose Vision?

Abstract

This chapter problematises the concept of ‘patient safety’ and unravels how it is understood and enacted by acute Trust staff, both managers and health care professionals, in the NHS in England. In understanding patient safety we focus on what the concept means to staff at different organisational levels, as well as how it is linked to wider organisational processes, structures and strategy, exposing the diverse practices, cultural attributes, competencies and processes that are wrapped up in its meaning. In particular, it is suggested that much good practice supportive of patient safety may be ‘unseen’ and ‘tacit’ (Mesman 2007) and that many factors impeding safety may not be direct, or located at the frontline or ‘sharp end’ (Dixon-Woods et al 2009). A primary focus is on staff perceptions of what is ‘patient safety’; any perceived links with staff well-being; and, what circumstances might facilitate or prevent them from providing safe care. We explore whether patient safety is approached by Trusts as a strategic system-wide change, connecting formal and informal practices, processes, cultural attributes, competencies, staff well-being and broader contextual factors; or if patient safety improvement is tackled as ‘initiative-driven’, piecemeal policy, with poor connectivity to strategy?