A New Structure of Attention?

Abstract

This article presents an inquiry into how clinicians realize a health policy reform initiative called Open Disclosure. Open Disclosure mandates that discussions with patients/family and team staff about "adverse events" are now no longer ad hoc, individualized, and without consequences for how the work is done, but planned, collaborative, and leading to systems change. The article presents an empirical analysis of a corpus of interviews about the impact of Open Disclosure on clinicians' practices. It situates Open Disclosure in the context of arguments that health care workers are increasingly expected to do "emotional labor" with patients and their families, in that staff are advised to practise "reflexive listening" as a means of managing patients' and family members' emotions in response to incidents. The analysis suggests that thanks to the intensity of Open Disclosure interactions, clinicians may be introduced to an affective-interactive space that they were hitherto unaware of and unable to enter or attain what Nigel Thrift calls "a new structure of attention."

Developments in Health Communication in the 21st Century

“…We revisit here the Taskforce papers by Hewett et al (2009) and Iedema et al (2009) and discuss new work emphasizing the importance of the intergroup relations between different health care professionals. We also incorporate Gallois’s theme concerning quality of care and adverse events, because we argue quality of patient care is linked to intergroup communication.…”

“…First, we revisit the foci of the papers in the Special Issue. Iedema, Jorm, Wakefield, Ryan, and Sorensen (2009) and Hewett, Watson, Gallois, Ward, and Leggett (2009) focused on the patient's experience in the hospital system and how adverse events occur and are subsequently dealt with in the hospital system. Hewett et al investigated how patient care can be adversely affected through ineffective communication between health professionals.…”

“…This focus has recently been taken up by and is discussed later in this paper. Iedema et al (2009) described the tension and distress underlying open disclosure of adverse events. The 'unpredictability' (p. 154) that surrounds the discourse between a patient and clinician, when the latter is explaining how care or procedures went wrong, is clearly alien and open disclosure is counter-intuitive for health professionals.…”

“…A key message from Hewett et al’s (2009) paper was the need to examine how the hospital system can work more effectively to ensure patient care is not compromised by the organizational dynamics that play out. Iedema et al’s (2009) paper showed that the same dynamics make it hard for clinicians to allow patients a voice during open disclosure discourse, in part because clinicians find it confronting to step back and question their clinical practice and procedures. Walshe and Shortell (2004) stated that a culture of secrecy and protectionism in health care is the most important barrier to health professionals admitting their mistakes to patients.…”

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

“…Further work undertaken by Iedema et al includes the assessment of open disclosure in terms of the impact on patients and health-care staff in Australia. [25][26][27] Qualitative analysis of interviews with 131 clinical staff and 23 patients/family members indicated that, despite some uncertainty surrounding the use and consequences of open disclosure, the system was strongly supported. 24 Further work has examined 119 patients' and family members' responses to questions about whether or not, and how, they experienced disclosure.…”