One event, three investigations: The reproduction of a safety norm
| Autor: | Jonas Wrigstad, Pelle Gustafson, Johan Bergström |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
adverse event
Poison control Discourse Medical and Health Sciences Occupational safety and health Safety norm 03 medical and health sciences 0302 clinical medicine Epistemological pluralism 0501 psychology and cognitive sciences 030212 general & internal medicine Macro Safety Risk Reliability and Quality 050107 human factors Other Social Sciences Investigation Healthcare 05 social sciences Public Health Environmental and Occupational Health Human factors and ergonomics Cognition Content analysis Norm (social) Causal factor Psychology Safety Research Social psychology Cognitive psychology |
| Zdroj: | Safety Science; 96, pp 75-83 (2017) |
| ISSN: | 0925-7535 |
| Popis: | Following an adverse event in a Swedish university hospital in 2010, three separate investigations seeking causal factors were conducted. We here review each of the analyses to see whether they together generate the kind of epistemological pluralism that could contribute to a systemic understanding of, and learning from, the event. Our content analysis shows that, while using vastly different amounts of time and resources, all three investigations make the same analytical choice to construct the causal factors as a deviation from norm in the event's immediate temporal and spatial proximity. We recognise that this both represents a strong discourse in the community analysing adverse events and seems to fulfil certain psychological purposes. Furthermore, we suggest that thorough analysis of adverse events in healthcare need to include aspects of system interaction from the micro to the macro, cognitive work configuration and design, as well as variability as a resource to harness rather than a threat to limit and control. |
| Databáze: | OpenAIRE |
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