It depends who you ask: Divergences in staff and external stakeholder narratives about the causes of a healthcare failure

Abstract

Investigations of institutional failure in healthcare typically use staff narratives to identify the cultural factors contributing to the incident. But, to what extent can staff, who are embedded in the culture and who were part of the failing, reflect on and report on the culture? We investigate this by comparing 40 witness statements from staff and 53 witness statements from patients and relatives collected by a public inquiry into a major UK healthcare failure (Clostridium difficile outbreak). Through quantitative text analysis, we found that, while staff and external stakeholders both recognised problems in care, they diverged on the factors considered paramount. Staff emphasised underlying factors such as under‐resourcing and training (causal culture), while patients and relatives emphasised corrective behaviours such as communication for identifying and taking precautions against the spread of C. difficile (corrective culture). The results indicate that patients and relatives may be able to report on cultural factors that staff do not report or are unaware of, thus allowing a more complete analysis. Even in light of an institutional failure, staff may have incomplete accounts of the contributing cultural factors, with implications for learning and postincident improvement.