McDonald Ruth, Waring Justin, Harrison Stephen
National Primary Care R&D Centre, University of Manchester, UK.
Sociol Health Illn. 2006 Mar;28(2):178-202. doi: 10.1111/j.1467-9566.2006.00487.x.
Patient safety has become a health policy priority around the world. Acknowledging that 'to err is human' has led to attempts to design systems and rules that limit the capacity for individual discretion and thereby reduce clinical errors. In addition, great emphasis is being placed on the need to eradicate cultures of blame, which are assumed to discourage clinicians from reporting errors, and to establish a 'safety culture', which encourages openness and honesty. These efforts are underpinned by cognitive psychological explanations of the way individuals process information, which leads them to make errors of judgement. This paper examines the attitudes of hospital doctors and managers to the implementation of rules in the context of patient safety. Our analysis, using interpretive research focused on narrative identity, provides an alternative perspective to that offered by the current safety orthodoxy. This leads us to suggest that the achievement of a 'safety culture' is a remote prospect. The failure to follow formal written rules relates not to a deficiency in the cognitive capacity of individuals acting in isolation, but to the identities which individuals occupy, create and negotiate and the social rules (as opposed to clinical guidelines or protocols) which correspond to those identities.
患者安全已成为全球卫生政策的优先事项。认识到“人非圣贤，孰能无过”，人们试图设计各种系统和规则，以限制个人自行决策的能力，从而减少临床失误。此外，人们还高度重视消除指责文化，因为这种文化被认为会阻碍临床医生报告失误，同时要建立一种“安全文化”，鼓励公开和坦诚。这些努力的依据是认知心理学对个体处理信息方式的解释，这种方式会导致他们做出判断失误。本文探讨了医院医生和管理人员在患者安全背景下对规则实施的态度。我们采用聚焦于叙事身份的解释性研究进行分析，为当前安全正统观念提供了另一种视角。这使我们认为，实现“安全文化”是一个遥远的前景。不遵守正式书面规则并非源于孤立行事的个人认知能力不足，而是源于个人所占据、创造和协商的身份，以及与这些身份相对应的社会规则（与临床指南或规程相对）。
