The York Management School, University of York, York, UK.
J Health Organ Manag. 2009;23(5):494-504. doi: 10.1108/14777260910983998.
This paper aims to utilise cultural theory of risk to provide a broad analytic framework for examining how risk is constructed within the dominant discourses around patient safety within the domain of psychiatry. It also seeks to examine notions of blame and to consider the possibility of the creation of a no-blame culture.
DESIGN/METHODOLOGY/APPROACH: The empirical element of the paper draws on qualitative interviews with a sample of psychiatrists to explore how culture may give rise to different perceptions and responses in respect of "risky behaviour" and "safe practice".
The paper discusses how psychiatry may be differentiated from other branches of medicine and concludes that the cultural grouping that appears to be most apposite in respect of psychiatrists is the egalitarian culture. However, changes in the NHS are resulting in the imposition of an individualistic culture on the community of psychiatrists with the effect that behaviours are being adopted as measures to avoid potential blame.
The paper finds that if the NHS is to improve patient safety then it must recognise that it is not possible to create a no-blame culture and, therefore, it is more important to consider which type of culture will impact most positively on patient safety. It appears that psychiatrists are being compelled to adopt an individualistic culture when an egalitarian culture would be more advantageous for patient safety.
ORIGINALITY/VALUE: In contrast with the methodological individualism of the current safety orthodoxy which interprets risk as an objective and measurable phenomenon, the paper draws on cultural theory of risk to develop a critical perspective on current safety policy and to explore how "risky" and "safe" practices are socially constructed in the context of psychiatry.
本文旨在利用风险的文化理论，为考察风险如何在精神病学领域围绕患者安全的主导话语中构建提供一个广泛的分析框架。它还试图探讨指责的概念，并考虑创造无责文化的可能性。
设计/方法/方法：本文的实证要素借鉴了对一组精神病医生的定性访谈，探讨文化如何引起对“风险行为”和“安全实践”的不同看法和反应。
本文讨论了精神病学如何与其他医学分支区分开来，并得出结论，在精神病医生方面似乎最合适的文化群体是平等主义文化。然而，国民保健制度的变化正在将个人主义文化强加给精神病医生群体，其影响是采取行为作为避免潜在指责的措施。
本文发现，如果国民保健制度要提高患者安全性，那么就必须认识到不可能创造一个无责文化，因此，更重要的是要考虑哪种文化将对患者安全产生最积极的影响。似乎当平等主义文化更有利于患者安全时，精神病医生被迫采用个人主义文化。
原创性/价值：与当前安全正统观念的方法论个人主义相反，该观念将风险解释为客观和可衡量的现象，本文利用风险的文化理论，对当前的安全政策进行批判性的审视，并探讨在精神病学背景下，“风险”和“安全”实践是如何在社会上构建的。
