A Socio-cultural Perspective on Patient Safety

Justin Waring, Emma Rowley

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781138072817
• eBook ISBN: 9781317186724
• Topic: Technology & Engineering
• Subtopic: Health Policy
• Index: Technology & Engineering

This edited volume of original chapters brings together researchers from around the world who are exploring the facets of health care organization and delivery that are sometimes marginal to mainstream patient safety theories and methodologies but offer important insights into the socio-cultural and organizational context of patient safety. By examining these critical insights or perspectives and drawing upon theories and methodologies often neglected by mainstream safety researchers, this collection shows we can learn more about not only the barriers and drivers to implementing patient safety programmes, but also about the more fundamental issues that shape notions of safety, alternate strategies for enhancing safety, and the wider implications of the safety agenda on the future of health care delivery. In so doing, A Socio-cultural Perspective on Patient Safety challenges the taken-for-granted assumptions around fundamental philosophical and political issues upon which mainstream orthodoxy relies. The book draws upon a range of theoretical and empirical approaches from across the social sciences to investigate and question the patient safety movement. Each chapter takes as its focus and question a particular aspect of the patient safety reforms, from its policy context and theoretical foundations to its practical application and manifestation in clinical practice, whilst also considering the wider implications for the organization and delivery of health care services. Accordingly, the chapters each draw upon a distinct theoretical or methodological approach to critically explore specific dimensions of the patient safety agenda. Taken as a whole, the collection advances a strong, coherent argument that is much needed to counter some of the uncritical assumptions that need to be described and analyzed if patient safety is indeed to be achieved.

PART 1

Patients and Publics

Chapter 1

‘All News is Bad News’: Patient Safety in the News Media

Cecily Palmer and Toby Murcott

This chapter explores the paradox of patient safety in the media: put simply, deficiencies in patient safety receive ample coverage, whereas the improvement and maintenance of patient safety receive far less. We present and reflect on the findings of a media impact assessment undertaken as part of a review of the UK-based programme of patient safety research: the Patient Safety Research Portfolio (PSRP). The assessment sought to identify and examine coverage of PSRP-funded patient safety research studies in the UK news media. We found only a single news story that referenced a PSRP study, even though 27 of the studies were complete at the time of our review. By contrast, stories covering serious or fatal patient safety incidents, strategies for improving patient safety in their aftermath and calls to improve patient safety made by those affected by such incidents were a regular feature in the UK news media at the time.

Existing studies of health and illness stories in the media have focused on coverage of patient safety failures in hospitals and health care settings, which frequently garner huge media attention (Stebbing and Kaushal 2006). Examples of incidents to have received major coverage in the UK news media include severe failings in emergency care involving Mid-Staffordshire NHS Foundation Trust and the death of a young man after the leukaemia drug Vincristine was mistakenly injected into his spine. Millenson (2002) argues that, though research on medical errors leading to the harm of patients had been published in the US context, this had led to little change in medical practice. He further claims that extensive media coverage of errors and fatal mistakes made by health professionals forced the profession to acknowledge this problem, and begin to establish organizations and develop the expertise necessary to prevent medical errors. Consistent with Millenson’s argument, the exposure and investigation of care failings at Mid-Staffordshire NHS Foundation Trust was preceded by sustained media coverage of the campaign started by Julie Bailey, whose mother died at the hospital due to ‘appalling emergency care’ (Healthcare Commission 2009). It can therefore be argued that media coverage of patient safety failures has played an important role in prompting professional and governmental responses to patient safety failures in health care settings.

This chapter will focus on the absence of patient safety success stories in the media, as illustrated by our investigation of media coverage of the PSRP research corpus, and attempt to explain why so few positive or hopeful patient safety stories were found in the media coverage. This omission is despite the existence of a considerable programme of research dedicated to investigating and improving patient safety. Having illustrated the paradox of patient safety in the media – that patient safety receives coverage when failing or deficient, whereas positive patient safety stories are largely absent, this chapter considers and reflects on the tension that has traditionally characterized the relationship between research communities and the mass media. It concludes with a strategy that patient safety researchers and research commissioners might use to address the imbalance in coverage of patient safety issues and research.

Assessing ‘Impact’: Search Strategy for News Media Coverage of the PSRP Studies

The PSRP was founded in June 2001 with the aim of identifying processes and structures that might reduce the probability of adverse clinical events and evaluating interventions seeking to change the health care system and improve patient safety (Lilford et al. 2005: 3). The PSRP commissioned 36 diverse, multidisciplinary research studies undertaken between 2001 and 2009¹ that examined and critically reflected upon the risks to the safety of patients; structures and processes that minimize such risks; and interventions with the potential to improve the overall safety of the NHS. We were part of the research team commissioned in 2008 to produce a narrative review of completed PSRP research studies that would summarize and synthesize the findings of the corpus (see Dingwall et al. 2009).

Part of the review assessed the impact of the PSRP research corpus in terms of coverage in both popular news media and specialist medical publications. Four approaches were used to determine the degree of coverage of patient safety research portfolio studies. Searches of Nexis, the comprehensive print news database, were used to identify UK local and national print news media coverage that could be directly linked or attributed to any of the PSRP studies. Full project titles were used as the primary search term and this was followed by searches using keywords from the titles of the studies. If 50 or fewer hits were located by the search, these were checked manually for references to the PSRP projects. If more than 50 hits were returned by the search, secondary searches were performed on the subset using the name of the relevant principal investigator, and separately, the names of study co-authors. In all cases an assessment of whether a story was linked or attributable to a PSRP study was made by reading the story in full and searching for specific references to the study, to the institution in which the study was undertaken and/or to the principal or co-investigators on the study.

A common criticism of medical and scientific communication studies is that ‘researchers studying media’ are in fact ‘researchers study[ing] newspapers’ (Gregory and Miller 1998: 105), and we therefore endeavoured also to include the outputs of non-textual broadcast media in our search strategy. We searched the websites of three major UK broadcast media agencies (BBC, ITN and Sky) for both audiovisual and text-based articles making reference to the PSRP projects. Each website was searched, using the full title of each PSRP research study and the names of the principal investigators and co-investigators as search terms. Hits located using the searches were checked manually for references or links to the PSRP study in question. These searches located no news stories that could be directly linked to any of the studies in the PSRP corpus of research.²

Our search of academic and professional publications covered four journals selected because of their relevance to health care professionals in the UK. Due to there being no central database for the large range of professional publications relevant to health care professionals in the UK, the pragmatic decision was made to search the archives of the British Medical Journal news section, The Lancet news section, the Nursing Times and the Health Services Research Journal for coverage of the PSRP studies. Our searches of these publications, using the same terms outlined above, located no stories that could be directly attributed to the PSRP corpus of research.

The press release archives from the home institutions of each principal investigator of a PSRP study were also searched to determine whether any of the institutions hosting PSRP research had produced related press releases. Our search relied on the online press release archives that are publicly accessible via most university websites, including the Universities of York, Newcastle, Nottingham, Manchester, Imperial College London, Salford, Dundee, Bristol, UCL and other institutions involved in 21 of the PSRP studies. We located just one press release about a PSRP study being undertaken at the University of Nottingham; however it did not appear to have contributed to an identifiable story in the popular media.

Finally, to get a broader sense of patient safety stories that occurred in UK newspaper coverage within the time frame of the PSRP research studies, we also searched the Nexis database using a small group of keywords that were common to much of the reporting of patient safety issues. These searches, which included the terms ‘e-prescribing’, ‘medication errors’ and ‘checklists’, were performed in order to produce a brief, pragmatic review of the type of story published in the popular media with reference to patient safety.

Our searches of the Nexis database for coverage of PSRP studies located a single story that was directly linked to a PSRP study. Published in The Times on 21 May 2003 (Wright 2003), the story covered the introduction of ‘aviation-style near-miss reports for family doctors’ and made reference to the findings of a specific PSRP study which examined the nature and frequency of medical errors in primary care (Sandars and Esmail 2001); it further included a number of quotes from the principal investigator of the study:

Doctors know from their own experience that things go wrong … often nothing happens as a result and there is no real harm done … what we don’t have is an accurate idea of the scale of the problem. In the past studies have tended to look at medical errors in hospitals and not primary care (Esmail, quoted in Wright 2003).

As news stories often evolve rapidly away from their original inspiration or stimulus without leaving an identifiable trail of facts or sources from which they originally derived, it is possible that further stories based on research from the PSRP corpus were not identified using this search strategy and we acknowledge this as a potential limitation to our work.

Categories of Patient Safety Story in the News Media

To summarize, our investigation of different media for coverage of the PSRP research studies, which incorporated searches of the websites of the major UK broadcast media agencies, of professional publications relevant to UK health practitioners, of university press release archives and of the Nexis print media database, located a single news story that could be directly linked to a research study within the PSRP corpus. While we only located a single story related to PSRP, our searches revealed that a variety of topics related to patient safety were featured at some length, especially in the UK newspapers. Our searches for the terms ‘electronic prescribing’ and ‘medication errors’ generated a number of hits on both the BBC website and in the Nexis database. The pragmatic review of patient safety stories using additional searches of the Nexis database found that patient safety issues featured regularly in the UK news media, and that this coverage could be separated into three broad categories.

The principal category of patient safety story referred to specific cases of safety failure in which a serious or fatal incident had occurred. The source for this type of story was typically an official announcement from the hospital or Trust at which the incident had occurred, as apparent in the following example:

Heartache for family over boy’s leukaemia medicine blunder. Hospital bosses have apologized after a six-year-old leukaemia patient was wrongly given too much steroid medication for two months. (Anon in Yorkshire Evening Post, 27 March 2007)

The second type of story covered calls from various sources, such as Members of Parliament, individuals affected by patient safety failures, or organizations representing patients, to improve patient safety. The key source for these stories was typically the individual or organization making the call for improved safety, as in the following examples from The Times and the Birmingham Post respectively.

Thousands of lives are being put at risk every year in the NHS because of the Government’s failure to set up an effective system to monitor patient safety and prevent mistakes recurring, an influential cross-party committee said yesterday. (Lister in The Times, 6 July 2006)

More needs to be done to cut hospital mistakes after figures revealed more than 40,000 medication errors in one year, the health regulator said yesterday. (Pinch in Birmingham Post, 12 August 2006)

The third category of coverage was of plans designed to improve patient safety, such as the World Health Organization’s surgical safety checklist for use in operating theatres that the National Patient Safety Agency (NPSA) required NHS Trusts to implement by February 2010: ‘Safety checklist to cut errors in operations for surgeons’ (Smith in The Daily Telegraph, 15 January 2009). Another common area for safety improvement was in relation to medications:

Drug safety watchdogs are preparing new guidance on prescribing, dispensing and administering anti-cancer and blood-thinning drugs after serious medication errors that have led to patients dying or being permanently harmed. (Meikle in The Guardian, 22 January 2004)

The source for this type of story was either the NHS or, since its establishment in 2002, the National Patient Safety Agency. Coverage of plans or innovations designed to improve patient safety usually referred to a serious incident from the past or to generic statistics on medical errors and accidents, as illustrated in the following extract:

World-wide, an estimated 234 million operations are carried out a year, and about one million people die each year following major surgery (BBC, 25 June 2008)

Since our search located only one news story in the popular media that directly referenced a PSRP research study aimed at improving patient safety, yet found numerous stories covering serious or fatal patient incidents, offering strategies for improvement in their aftermath or making calls to improve patient safety from those affected by such incidents, we can suggest that patient safety tends to receive media coverage only when it is found to be lacking or deficient.

Rejecting ‘Inaccuracy’: Understanding News Media Coverage of Research

So how then are we to understand the selection of patient safety stories that receive coverage in the media? Moreover, what can we learn about why a programme of research specifically designed to improve safety for patients in the NHS and beyond was largely ignored within media coverage? Historically there has been a tendency for scientific and medical communities to criticize the media for their choice of scientific and medical stories and the style and manner that such coverage has taken (Nelkin 1996). Following this line of argument, coverage of patient safety ‘failures’, and the limited coverage of patient safety ‘successes’ or progress might be taken as further evidence to support the notion of a media that ‘fails’ to cover science, medicine or research in these areas, in an ‘accurate’ or educational manner. Such criticisms have however been convincingly critiqued in their own right by scholars examining the popular communication of scientific and medical research (Nelkin 1996, Gregory and Miller 1998, Seale 2002, Schudson 2003). These scholars draw attention to the fundamental assumptions underlying attacks on media ‘accuracy’. Seale notes how ‘“inaccuracy” or misrepresentation in the media is perceived by critics to have a direct and potentially “damaging” effect of some kind’ (2002: 51). A second and broader assumption on the part of such critics is that it is in some way the ‘job’, or obligation of the media to educate or inform ‘the public’ in a manner of which those who work in science and medicine would approve.

Nelkin identifies an ‘enduring tension’ between medicine and the media and suggests that ‘perhaps the most important source of strain between scientists and journalists lies in their different views about the media’s role’ (1996: 1602). She outlines scientists’ view of the media as documented by science communication scholar Jon Turney (1996):

They view the press as a conduit or pipeline, responsible for transmitting science to the public in a way that can be easily understood. Scientists expect to control the flow of information to the public as they do within their own domain … they assume that the purpose of science journalism is to convey a positive image; they see the media as a means of furthering scientific and medical goals. Most journalists, however, do not see themselves as trumpets for science. (Nelkin 1996: 1602)

In a similar vein, Gregory and Miller (1998) identify the propensity of scientists to engage in assertions regarding how the media ‘should’ be working. They argue ‘high on scientists’ agenda has been the question of accuracy – that is, the extent to which popularizations faithf...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Author Biographies
• Foreword by Paul Barach
• Introduction: A Socio-cultural Perspective on Patient Safety
• PART 1 PATIENTS AND PUBLICS
• PART 2 CLINICAL PRACTICE
• PART 3 TECHNOLOGY
• PART 4 KNOWLEDGE SHARING
• PART 5 LEARNING
• Concluding Remarks: The Gaps and Future Directions for Patient Safety Research
• Index