A Transactional Approach to Patient Safety: Understanding Safe Care as a Collaborative Accomplishment

Kirstine Zinck Pedersen*, Jessica Mesman

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Within the last two decades, it has been commonly agreed that patient safety and error management in healthcare organizations can best be attained by adopting a systems approach via re-engineering efforts and the introduction of industrial safety technologies and methodologies. This strategy has not delivered the expected result. Based on John Dewey’s pragmatism, we propose another vocabulary for understanding, inquiring into and learning from safety situations in healthcare. Drawing especially on Dewey’s understanding of transaction as the inseparability between human and environment, we develop an analytical approach to patient safety understood as a transactional accomplishment thoroughly dependent on the quality of situated and shared habits and collaborative practices in healthcare. We further illustrate methodologically how a transactional attitude can be situationally practised through video-reflexive ethnography, a method that allows for inquiry into mundane safety practices by letting interprofessional teams see, reflect upon and possibly modify their shared practices and safety habits.
Original languageEnglish
JournalJournal of Interprofessional Care
Issue number4
Pages (from-to)503-513
Number of pages11
Publication statusPublished - Jul 2021

Bibliographical note

Published online: 02 Mar 2021.


  • Transation
  • Patient safety
  • Systems approach
  • Video-relexive ethnography
  • Collaborative practices
  • Pragmatism

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