Waring Justin, Harrison Steve, McDonald Ruth
School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
J Health Serv Res Policy. 2007 Apr;12 Suppl 1:S1-3-9. doi: 10.1258/135581907780318347.
The creation of a 'safety culture' is a health services priority, yet there is little contemporary research examining the tacit, customary practices that relate to clinical risk. This paper investigates how the ritualistic behaviours of surgeons and anaesthetists serve to normalize risks within the operating theatre, thereby inhibiting organizational learning and enabling such risks to recur.
A two-year ethnographic study in the operating department of a large teaching hospital in the north of England, including observations of the organizational and clinical setting and interviews with 80 members of staff.
Three ritualistic types of behaviour are identified and described. Each illustrates the taken-for-granted assumptions associated with clinical risk in the operating theatre and is characterized by a patterned response to risk, the first being to tolerate and endure risk, the second being to accommodate risk through slight modifications to clinical practice and the third being to innovate or implement unorthodox practices to control for risk.
These ritualistic behaviours normalize risk within the operating theatre leading to the possibility that some threats will escape appropriate attention and may lead to patient harm. These culturally scripted behaviours also encourage a short-term reactive response to risk that emphasizes the importance of individual coping rather than the more systemic forms of learning associated with participation in incident reporting. This research extends and elaborates upon the current policy orthodoxy to better understand the cultural context of patient safety.
营造“安全文化”是医疗服务的一项优先任务，但目前几乎没有当代研究审视与临床风险相关的隐性、习惯性做法。本文调查外科医生和麻醉师的仪式化行为如何使手术室中的风险正常化，从而抑制组织学习并使此类风险再次发生。
在英格兰北部一家大型教学医院的手术室进行了为期两年的人种志研究，包括对组织和临床环境的观察以及对80名工作人员的访谈。
识别并描述了三种仪式化行为类型。每种行为都说明了与手术室临床风险相关的理所当然的假设，其特点是对风险的一种模式化反应，第一种是容忍和承受风险，第二种是通过对临床实践进行轻微调整来适应风险，第三种是创新或实施非正统做法来控制风险。
这些仪式化行为使手术室中的风险正常化，导致一些威胁可能得不到适当关注，并可能导致患者受到伤害。这些由文化塑造的行为还鼓励对风险采取短期的反应性应对措施，强调个人应对的重要性，而不是与参与事件报告相关的更具系统性的学习形式。这项研究扩展并阐述了当前的政策正统观念，以更好地理解患者安全的文化背景。
