Standardisation or Resilience? The Paradox of Stability and Change in Patient Safety

Research output: Contribution to journalJournal articleResearchpeer-review

115 Downloads (Pure)

Abstract

This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation's resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre-empts certain types of safety solutions. Drawing on John Dewey's influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.
Original languageEnglish
JournalSociology of Health and Illness
Volume38
Issue number7
Pages (from-to)1180–1193
Number of pages14
ISSN0141-9889
DOIs
Publication statusPublished - 2016

Keywords

  • Patient safety
  • Standardisation
  • Resilience
  • Stability
  • Change
  • John Dewey
  • System engineering
  • Medical uncertainty

Cite this

@article{23db821149f4406eb5c87c2299c3f1e2,
title = "Standardisation or Resilience?: The Paradox of Stability and Change in Patient Safety",
abstract = "This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation's resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre-empts certain types of safety solutions. Drawing on John Dewey's influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.",
keywords = "Patient safety, Standardisation, Resilience, Stability, Change, John Dewey, System engineering, Medical uncertainty, Patient safety, Standardisation, Resilience, Stability, Change, John Dewey, System engineering, Medical uncertainty",
author = "Pedersen, {Kirstine Zinck}",
year = "2016",
doi = "10.1111/1467-9566.12449",
language = "English",
volume = "38",
pages = "1180–1193",
journal = "Sociology of Health and Illness",
issn = "0141-9889",
publisher = "Blackwell Publishing",
number = "7",

}

Standardisation or Resilience? The Paradox of Stability and Change in Patient Safety. / Pedersen, Kirstine Zinck.

In: Sociology of Health and Illness, Vol. 38, No. 7, 2016, p. 1180–1193.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Standardisation or Resilience?

T2 - The Paradox of Stability and Change in Patient Safety

AU - Pedersen, Kirstine Zinck

PY - 2016

Y1 - 2016

N2 - This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation's resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre-empts certain types of safety solutions. Drawing on John Dewey's influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.

AB - This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation's resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre-empts certain types of safety solutions. Drawing on John Dewey's influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.

KW - Patient safety

KW - Standardisation

KW - Resilience

KW - Stability

KW - Change

KW - John Dewey

KW - System engineering

KW - Medical uncertainty

KW - Patient safety

KW - Standardisation

KW - Resilience

KW - Stability

KW - Change

KW - John Dewey

KW - System engineering

KW - Medical uncertainty

UR - https://sfx-45cbs.hosted.exlibrisgroup.com/45cbs?url_ver=Z39.88-2004&url_ctx_fmt=info:ofi/fmt:kev:mtx:ctx&ctx_enc=info:ofi/enc:UTF-8&ctx_ver=Z39.88-2004&rfr_id=info:sid/sfxit.com:azlist&sfx.ignore_date_threshold=1&rft.object_id=954925471355

U2 - 10.1111/1467-9566.12449

DO - 10.1111/1467-9566.12449

M3 - Journal article

VL - 38

SP - 1180

EP - 1193

JO - Sociology of Health and Illness

JF - Sociology of Health and Illness

SN - 0141-9889

IS - 7

ER -