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Title: What is the role of individual accountability in patient safety? A multi-site ethnographic study
Authors: Aveling, Emma-Louise
Parker, Michael
Dixon-Woods, Mary Margaret
First Published: 4-Nov-2015
Publisher: Wiley for the Foundation for the Sociology of Health and Illness
Citation: Sociology of Health and Illness, 38 (2), 2015
Abstract: An enduring debate concerns how responsibility for patient safety should be distributed between organizational systems and individual professionals. Though rule-based, calculus-like approaches intended to support a “just culture” have become popular, they perpetuate an asocial and atomised account. In this article, we use insights from practice theory – which sees organizational phenomena as accomplished in everyday actions, with individual agency and structural conditions as a mutually constitutive, dynamic duality - along with contributions from the political science and ethics literature as a starting point for analysis. Presenting ethnographic data from five hospitals, three in one high-income country and two in low-income countries, we offer an empirically informed, normative rethinking of the role of personal accountability, identifying the collective nature of the healthcare enterprise and the extent to which patient safety depends on contributions from many hands. We show that moral responsibility for actions and behaviours is an irreducible element of professional practice, but that individuals are not somehow “outside” and separate from “systems”: they create, modify and are subject to the social forces that are an inescapable feature of any organisational system; each element acts on the other. Our work illustrates starkly the structuring effects of the broader institutional and socio-economic context on opportunities to “be good” .These findings imply that one of the key responsibilities of organisations and wider institutions in relation to patient safety is the fostering of the conditions of moral community.
DOI Link: 10.1111/1467-9566.12370
ISSN: 0141-9889
eISSN: 1467-9566
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Appears in Collections:Published Articles, Dept. of Health Sciences

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