Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room

Abstract

This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of ''vulnerable system syndrome'', Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into key trends in the interview data, including team members' definition of error as the breaching of standards of practice, nurses' sense of scope of practice as a constraint on their reporting behaviours, and participants' reports of the forces influencing tacit agreements to work around safety regulations. However, the relational factors underlying unsafe practice routines are poorly accounted for in these theoretical approaches. Incorporating an additional theoretical construct such as ''relational coordination'' to account for the emotional human features of team practice would provide a more comprehensive theoretical approach for use in exploring unsafe practice routines and the forces that sustain them in healthcare team settings.

Nurses' experiences with errors in nursing

“…Although nurses are the healthcare professionals who most frequently report errors, many continue to harbor fears about reporting them (Bayazidi, Zraezadeh, Zamanzadeh, & Parvan, 2012;Cook, Hoas, Guttmannova, & Joyner, 2004;Espin, Lingard, Baker, & Regehr, 2006;Hartnell MacKinnon, Sketris, & Fleming, 2012;Osmon et al, 2004;Rowin et al, 2008;Prang & Jelsness-Jorgensen, 2014;Uribe, Schweikhart, Pathak, Dow, & Marsh, 2002). In many institutions, the workplace culture regarding error reporting remains one of blame, and nurses are often concerned about personal repercussions associated with reporting errors (Blair, Kable, Courtney-Pratt, & Doran,2015;Castel, Ginsburg, Zaheer, & Tamin, 2015;Cook et al, 2004;Espin et al, 2006;Jeffe et al, 2004;Stratton, Blegen, Pepper, & Vaughn, 2004;Taylor et al, 2004;Uribe et al, 2002). A better understanding of nurses' decision-making regarding error reporting and workplace factors that influence their decisions can inform the development of strategies to improve the frequency and accuracy of error reporting by nurses.…”

Building Clinical and Organizational Resilience to Reconcile Safety Threats, Tensions and Trade-Offs: Insights from Theory and Evidence

“…Espin and colleagues (2006a )examined how healthcare professionals interact with one another in the context of perceived errors of care, and explored the factors influencing the persistence of unsafe practice (Espin et al 2006a ). Operating room nurses, surgeons and anesthesiologists were interviewed and provided with team-based error scenarios to prompt discussion during the interviews.…”

“…Microsystems evolve over time in response to the balancing act of healthcare professionals meeting patient needs within the context of work processes and patterns specific to the environment in which they provide care (Barach and Johnson 2006). Relating this balancing act to patient safety, the clinical microsystem is where patients, practitioners and patterns of practice interact to determine the safety of care processes (Espin et al 2006a) and their response to emergent safety threats. Thus, managing complex situations within healthcare requires attention to emergent threats at both clinical and organizational levels (Joyce et al 2005).…”

Anaesthetists learn – do institutions also learn?

“…Konflikte sind vorprogrammiert [25]. Durchschnittlich werden vier Konflikte pro Eingriff beob achtet.…”