Technical rationality and the decentring of patients and care delivery: A critique of ‘unavoidable’ in the context of patient harm

Abstract

In recent decades, debate on the quality and safety of healthcare has been dominated by a measure and manage administrative rationality. More recently, this rationality has been overlaid by ideas from human factors, ergonomics and systems engineering. Little critical attention has been given in the nursing literature to how risk of harm is understood and actioned, or how patients can be subjectified and marginalised through these discourses. The problem of assuring safety for particular patient groups, and the dominance of technical forms of rationality, has seen the word 'unavoidable' used in connection with intractable forms of patient harm. Employing pressure injury policy as an exemplar, and critically reviewing notions of risk and unavoidable harm, we problematise the concept of unavoidable patient harm, highlighting how this dominant safety rationality risks perverse and taken-for-granted assumptions about patients, care processes and the nature of risk and harm. In this orthodoxy, those who specify or measure risk are positioned as having more insight into the nature of risk, compared to those who simply experience risk. Driven almost exclusively as a technical and administrative pursuit, the patient safety agenda risks decentring the focus from patients and patient care.

Identifying and resisting the technological drift: green space, blue space and ecotherapy

“…The caring professions noted above have been widely critiqued for becoming task orientated rather than person centred (Hutchinson, Jackson and Wilson, 2018) and there is no reason to suggest that nature and healthonce efficiently integrated into healthcarewill be any different. As nature is colonised as a technology training courses will need to be offered to endow 'experts' with the knowledge required to operationalise these resources efficiently (as we illustrated in the examples above).…”

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families

“…Although we consider that professional boundary maintenance is vital and requires critical reflection, we recognise that from a Heideggerian perspective, these moments may be an expression of shared meaning, being-in-the-world with another (Gullick et al, 2020). The Smythe et al (2018) 2010) rather than a decentring of patient caring through an administrative focus on risk (Hutchinson et al, 2018). The data provided wide-ranging examples of healthcare workers' experiences where participants drew from their caring values to inform the balance of leaping in and leaping ahead of patients and families (Heidegger, 2008).…”

“…Significantly, in the current study, health professionals recounted actions that took into consideration what patients and their families wanted, rather than what clinicians thought was best for people generically. This orientation typifies the tailoring of care recommended by Tronto (2010) rather than a decentring of patient caring through an administrative focus on risk (Hutchinson et al, 2018). The data provided wide‐ranging examples of healthcare workers' experiences where participants drew from their caring values to inform the balance of leaping in and leaping ahead of patients and families (Heidegger, 2008).…”

“…These include the techno‐rational agenda of biomedical healthcare; neoliberal approaches focused on the commodification of persons as units of economic productivity; and care rationing. These contexts risk reducing good care to a series of provider‐driven communications involving predetermined assessments and checklists (Hutchinson et al, 2018; Khademi et al, 2017; Tronto, 2010; Waterfield & Barnason, 2022). While techno‐rational skill acquisition is a fundamental requirement of good care in modern healthcare, this article adds to the extant empirical literature about the importance of relational aspects of care not being subsumed by biomedicalisation and specialisation.…”

A HAPI Opinion Commentary

“…The Task Force decided to undertake a literature review to see what others may have found, help determine what was potentially affecting our scores, and ascertain whether there were interventions we had not considered or implemented. A comprehensive literature search conducted by one of the health system librarians encompassed practice issues, regulatory and coding concerns, and PI classification 1–26 …”