Rules, safety and the narrativisation of identity: a hospital operating theatre case study

McDonald, Ruth; Waring, Justin; Harrison, Stephen

doi:10.1111/j.1467-9566.2006.00487.x

Cited by 93 publications

(126 citation statements)

References 43 publications

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“…Striving for perfection is consistent with the idea of medicine as a vocation [30] rather than technical work or contract-based profession. Errors are regarded as non-existent anomalies in the medical system.…”

Section: Self-doubtmentioning

confidence: 56%

“…Few other safety-critical domains have retained the actor autonomy and craftsman mindset of many medical specialties, in which professionals with equal positions are not viewed as equivalent. Systematization of practice and assumptions of actor equivalence reign in several domains, from commercial aviation to nuclear power, but are relatively new in healthcare [28][29][30] .…”

Section: Introductionmentioning

confidence: 99%

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Second victims, organizational resilience and the role of hospital administration

Santomauro

Kalkman

Dekker

2014

JHA

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Second victims are practitioners involved in an incident that (potentially) harms or kills somebody else, and for which they feel personally responsible. Professional culture and the psychology of blame (and shame) influence how second victims are viewed and dealt with. This paper reviews the status of second victimhood in healthcare -both its symptomatology and organizational responses. Then it considers the problematic nature of "human error" in healthcare and sets this against the psychological backdrop of healthcare professions, seeking cultural-historical explanations in assumptions of actor autonomy and professional identity. It concludes by drawing links between the psychological resilience of the individual practitioners involved in an incident and the resilience of an organization's safety culture.

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Section: Self-doubtmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Second victims, organizational resilience and the role of hospital administration

Santomauro

Kalkman

Dekker

2014

JHA

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“…This is not an atomistic identity but involves recognition from one's peers. In other words, shared norms in relation to what it means to be a professional are important in relation to feelings of self-worth and fulfilment [26]. However, because these norms relate to active treatment, making decisions that involve explicitly scaling back or stopping such treatment is not an easy process.…”

Section: Avoidance Of Warehousingmentioning

confidence: 99%

Ethical issues of long-term forensic psychiatric care

Völlm

Βartlett

McDonald

2016

Ethics, Medicine and Public Health

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Summary Forensic psychiatry is a subspecialty of clinical psychiatry that operates at the interface between law and psychiatry. It is concerned with patients who have a mental disorder as well as having committed an offence, often serious. Forensic psychiatric institutions are highcost/low-volume services that impose significant restrictions upon their residents. Patients may be detained in those services against their will for lengthy periods, potentially life-long. The purpose of this detention is seen as two-fold: care and treatment for the patient and protection of the public from harm from the offender. Here we review the ethical issues around such longterm detention. We base our observations on a review of relevant literature and from focus groups with professionals working in forensic psychiatric settings. Additionally, we visited three institutions in the UK where long-stay forensic psychiatric patients receive care. A number of factors have been identified contributing to long-term stay (long-stay) in forensic psychiatric care, including organisational factors (e.g., lack to beds in less secure settings) and patient characteristics (severity of psychopathology and offending). Long-stay in a forensic psychiatric setting -which is often longer than had the patient received a prison sentence for the same offence -poses significant ethical and human rights issues, particularly when it is unclear * Corresponding author. Please cite this article in press as: Völlm B, et al. whether the treatments offered benefit the patient and when risk management considerations may outweigh the best interests of the patient. The main topics of concern identified by our participants included ''system failures'', ''avoidance of warehousing'', ''importance of hope'', ''denial'' and long-stay units and ''quality of life''. Participants were concerned that the system is set up in a way that does not allow patients with complex and long-term needs to move to more appropriate, less restrictive settings and that the issue of ''long-stay'' is met with denial. In order to avoid warehousing and maintain hope, those we spoke to felt it was important to not give up on patients and continue to deliver treatment, almost regardless of its effect. Providing long-stay patients with a good quality of life was seen as important, though we found that the stated ambitions were not always matched by the reality of the units we visited. Despite the stated need to provide something ''different'' for long-stay patients, the units were nevertheless very restrictive in their approach (e.g., prohibition of sexual expression). Professionals seemed to lack a more ambitious and creative vision to create something truly distinct. We discuss possible solutions, including explicitly maximising the quality of life of those detained, limiting the time of detention to equal the sentence length of non-disordered offenders and locating the public protection function of the management of mentally disordered offenders within the criminal justice rather than the he...

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“…This disparity between doctor and non-doctor opinion is consistent with the paradigmatic differences between doctors and non-doctors as a vertical divide, where the divide in mindsets between a hospital's status coalition (doctors) and insider coalition (managers and nurses) is evidenced. 7,19 …”

Section: Doctors Versus Non-doctorsmentioning

confidence: 99%

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Fitzgerald¹,

Wu²

2017

Aust. Health Review

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Objective. This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list.Methods. A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants.Results. There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres.Conclusions. Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations.What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon's demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital. What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources. What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.

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Rules, safety and the narrativisation of identity: a hospital operating theatre case study

Cited by 93 publications

References 43 publications

Second victims, organizational resilience and the role of hospital administration

Second victims, organizational resilience and the role of hospital administration

Ethical issues of long-term forensic psychiatric care

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

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