Structuring and Disciplining Apology: A Structurational Analysis of Health Care Benevolence Laws

Abstract

Health care benevolence laws, a form of tort reform law, mandate statements of sympathy or apology by health care providers and facilities in cases of medical mistakes. These laws create a shared language and sense of meaning for individuals involved in the legal aftermath of medical mistakes. Structuration theory guides this textual analysis to explore how benevolence laws discursively create and structure shared meaning about apology. This analysis highlights how benevolence laws structure apology and discursively discipline medical practitioners, underscoring the importance of ambiguity in law interpretation.

The Structuration of Community-Based Mental Health Care: A Duality Analysis of a Volunteer Group’s Local Agency

“…Previously, scholars have critiqued the use of structuration theory in empirical work given the abstract general propositions and that it is not easily coupled with a specific methodological approach (Archer, 2007; Pozzebon & Pinsonneault, 2005). While communication scholars have employed structurational perspectives to various health care phenomenon (e.g., informed consent laws, space and materiality, physician apology laws), this study extends structuration methods with a volunteer group (Carmack, 2010a, 2010b; Olufowote, 2008, 2009). A duality analysis was conducted by including multiple sources of discourse (e.g., law and policy texts, member accounts, behavior, and resource data) and analyzing these data iteratively by focusing on subcategories of structure: domination, signification, and legitimation.…”

“…Structuration theory is a useful lens to document health care issues as they manifest in daily discourse (e.g., Carmack, 2010b;Olufowote, 2008). For example, Olufowote's (2009Olufowote's ( , 2008 work on informed consent laws demonstrated how sociohistorical and litigation movements manifested in physician discourse in unexpected and unintended ways.…”

Agentic Denial: How Athletic Teams Sustain Divergent Structures During Concussion Events

“…Structuration theory (Giddens, 1984) is a tool researchers have utilized to document group members’ use, creation, and perpetuation of material and symbolic structures through d/Discourse 1 (see Carmack, 2010a, 2010b; Real & Poole, 2011). The current study uses Alvesson and Kärreman’s (2000) distinction between little “d” discourse (i.e., everyday talk) and big “D” discourse (i.e., ways of talking and, therefore, ways of thinking).…”

A Cycle of Redemption in a Medical Error Disclosure and Apology Program

“…Since the release of the Institute of Medicine’s report on medical mistakes (Kohn, Corrigen, & Donaldson, 1999), health care reform advocates, hospital administrators, and health care providers have struggled to develop and implement a new approach to medical errors and patient safety. Two of the more popular approaches include the passage of state health care benevolence laws, which dictate the types of emotions and language practitioners can use when discussing medical errors with patients (Carmack, 2010b), and the increased use of morbidity and mortality conferences, at which practitioners talk about negative outcome cases (Gawande, 2002). Neither of these approaches encourages open and honest communication between patients and providers, which is recommended by The Joint Commission on Accreditation of Healthcare Organizations (2005).…”

“…Over the past two decades, communication and applied health scholars have slowly begun to explore the communicative nature of medical mistakes. Researchers have focused on how physicians construct and enact responses to errors (Mizrahi, 1984), how they disclose medical mistakes (Allman, 1998; Carmack, 2010b; Hannawa, 2009; Petronio, 2006), how physicians negotiate the aftermath of adverse events (Carmack, 2010a; Noland & Carl, 2006), and how practitioners are socialized to communicate errors (Noland & Rickles, 2009). Researchers have yet to explore the ways organizational programs, such as disclosure and apology programs, influence practitioners’ experiences by formally disclosing medical errors.…”