What is the role of individual accountability in patient safety? A multi-site ethnographic study

• Published in: The Sociology of Healthcare Safety and Quality pp. 36 - 51
• Main Authors: Aveling, Emma‐Louise, Parker, Michael, Dixon‐Woods, Mary
• Format: Book Chapter
• Language: English
• Published: United Kingdom John Wiley & Sons, Incorporated 2016; John Wiley & Sons, Ltd
• Subjects: Dennis Thompson; ethnographic studies; healthcare quality; healthcare safety; individual professionals; organisational systems; patient safety; personal accountability
• ISBN: 1119276349; 9781119276340
• DOI: 10.1002/9781119276371.ch3

This chapter discusses how to distribute responsibility between organisational systems and individual professionals. It shows how to identify individual contributions to patient safety given that the potential contributors may be multiple and widely diffused, for example across teams, organisations (and their internal strata and divisions), and wider institutions. Described by the political philosopher Dennis Thompson, it applies to situations where people contribute in many different ways to particular outcomes, so that the 'profusion of agents obscures the location of agency'. His analysis provides empirical support for understanding patient safety both as contingent on the dynamic, emergent and recursive duality of structure and agency in healthcare settings. Yet, as practice theory makes clear, such a framework is, by itself, likely to be sterile in the absence of empirical evidence. The chapter considers a framework as a starting point for analysis of the role of personal accountability for patient safety using ethnographic data from contrasting hospital contexts.