Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error

Iedema, Rick; Jorm, Christine; Long, Debbi; Braithwaite, Jeffrey; Travaglia, Joanne; Westbrook, Mary T.

doi:10.1016/j.socscimed.2005.08.049

Cited by 93 publications

(74 citation statements)

References 13 publications

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“…While some learning opportunities lead to automatic reduction of errors and failures, this concerns mainly errors such as slips and mistakes. In contrast knowledge-based errors and failures require more deliberate reflection to reduce the likelihood of repeating them (Iedema et al 2006 has gone wrong and how to improve procedures. Interestingly, the positive interaction effect suggest that information-based experience can have an increasing return on failure learning.…”

Section: Individual and Group Level Opportunities To Learn From Failurementioning

confidence: 99%

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

Dahlin

Chuang

Roulet

2018

ANNALS

197

106

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Section: Individual and Group Level Opportunities To Learn From Failurementioning

confidence: 99%

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

Dahlin

Chuang

Roulet

2018

ANNALS

197

106

View full text Add to dashboard Cite

“…The focal point of theories of medical dominance is that physicians occupy a dominant position in the health care division of labour that affords them autonomy over their own work and the work of other clinical groups (Freidson, 1988;Willis, 1989). Over the past few decades there has been debate about the continued degree of medical dominance given political, social and technological changes (Boyce, 2006;Broom, 2006;Nugus, Greenfield, Travaglia, Westbrook, & Braithwaite, 2010), as well as the impact of dynamic professional boundaries due to changes in the healthcare workforce and patient safety concerns (Iedema et al, 2006;Nancarrow & Borthwick, 2005). Structural and organizational changes provide the possibility for greater independence of health occupations such as physiotherapy, occupational therapy and social work that in turn re-draws professional boundaries (Boyce, 2006).…”

Section: Introductionmentioning

confidence: 99%

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

Goldman

Reeves

et al. 2016

Journal of Interprofessional Care

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Patient discharge is a key concern in hospitals, particularly in acute care given the multifaceted and challenging nature of patients' health care needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and micro-level practices. An ethnographic approach was employed to obtain an in-depth insight into health care providers' perspectives, 2 of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.

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“…The notion of the gaze is also helpful because it is applicable to the growing self-reflexivity of the medical profession. In the context of quality and patient safety initiatives, such reflexivity of the gaze might also engender a "micro-sociology" rather than questioning the "over-arching governance and structuring" of health care organisations or institutions (Iedema et al, 2006).…”

Section: The Gazementioning

confidence: 99%

The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

Exworthy

2015

P&P

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This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession's ability to re-cast and enhance its position (vis-à-vis managerial interests).Keywords: medical profession, medical control, iron cage, gaze This paper explores the modes of control of doctors by health-care institutions. Primarily, it assesses the value of applying two theoretical ideal-types to understand and explain physician (medical) control. It is argued that such modes of control have a significant bearing upon doctors' motivation, job satisfaction and ultimately the quality of care which they deliver.The paper is organised in three sections. First, it summarises the main arguments of the two ideal-types: the "cage" and the "gaze." These ideal-types need elaboration to enable their application to the context of the medical profession. Second, the paper outlines two empirical examples of medical performance and financial incentives relating to medical pay in the English National Health Service (NHS). This section examines these examples as illustrations and applications of the control. Finally, the paper draws conclusions about the value of such conceptual approaches in explaining the management and control of doctors. Ideal-types of occupational controlDrawing on Reed's (1999) thesis, this section presents two ideal-types which represent contrasting perspectives upon control of occupations by managerial and other external interests. The ideal-types are heuristic devices which generalise experiences from Western countries, specifically the UK. During the second half of

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Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error

Cited by 93 publications

References 13 publications

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

Opportunity, Motivation, and Ability to Learn from Failures and Errors: Review, Synthesis, and Ways to Move Forward

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

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