Understanding the impact on care practices of quality and safety initiatives
Open Disclosure
How prepared are clinicians to openly discuss adverse events that took place in their or their colleagues' departments?
Open Disclosure involves clinicians in being open with patients about clinical mishaps, commonly referred to as 'adverse events'. Previous experience has shown that Open Disclosure is important for reassuring patients that the health organization is doing all it can to rectify any adverse event that may have affected them. Open Disclosure has been argued to enhance relationships among all involved in adverse incidents.
The purpose of this project is to evaluate the Open Disclosure pilot study initiated by the Australian Commonwealth, Queensland Health and the Australian Commission on Safety and Quality in Health Care.
Reports
Iedema, R., Mallock, N., Sorensen, R., Manias, E., Tuckett, A., Williams, A., Perrott, B., Brownhill, S., Piper, D., Hor, S., Hegney, D., & Scheeres, H. (2007). Final Report: Evaluation of the National Open Disclosure Pilot Program. 30 November 2007. Sydney: University of Technology, Sydney.
Iedema, R., Manias, E., Westbrook, M., Hegney, D., Piper, D., Forsyth, R., Hor, S., Nugus, P., Mallock, N., Williams, A., McManus, J., Scheeres, H., Sorensen, R., Perrott, B., & Braithwaite, J. (2007). Interim Report: Evaluation of the National Open Disclosure Pilot Program. 29 June 2007. Sydney: University of Technology, Sydney.
Papers
Iedema, R., Mallock N, Sorensen, R. Manias, E., Tuckett, A., Williams, A. Perrot, B., Brownhill, S., Piper, D., Hor, S., Hegney, D., Scheeres, H. Jorm, C. (accepted for publication) The National Open Disclosure Pilot: Evaluation of a Policy Implementation Initiative. Medical Journal of Australia [submitted 20 December 2007; accepted 31 January 2008]
Iedema, R., Jorm, C., Wakefield, J., & Ryan, C. (under review). A New Structure of Attention? Open Disclosure of Unexpected Clinical Outcomes to Patients and their Families. Journal of Language & Social Psychology. [submitted 31 January 2008]
Iedema, R., Jorm, C., Wakefield, J., Ryan, C. & Dunn S. (under review). Learning to do Open Disclosure: The Ethics and Affects of Organizational Failure Communication. Sociology of Health & Illness.
Root Cause Analysis
What are the implications of clinical colleagues investigating adverse events that occurred in your department?
Root Cause Analysis provides a technique for clinicians to investigate incidents in an impartial way. But in practice this technique cuts right across existing working relationships and hierarchies. Adding to people's uncertainties about 'what went wrong', RCA puts relationships at risk in new ways. RCA requires clinicians not just to practise complex kinds of organizational analysis, but also to develop 'social intelligence' and 'heedfulness' (Weick & Roberts 1993).
Iedema, R., Jorm, C.M., Braithwaite, J., Travaglia, J. , & Lum, M. (2006). A root cause analysis of clinical errors: Confronting the disjunction between formal rules and situated clinical activity. Social Science & Medicine, 63(5), 1201-1212.
Iedema, R., Jorm, C.M., Long, D., Braithwaite, J., Travaglia, J., & Westbrook, M. (2006). Turning the Medical Gaze in upon Itself: Root Cause Analysis and the Investigation of Clinical Error. Social Science & Medicine, 62(7), 1605-1615.
Clinical Error Reporting
What are the interpersonal and social implications of:
- reporting clinical errors?
- constructing an error account or narrative?
Incident reporting was introduced into health care as a paper-based practice. These forms used to have sections that needed to filled out called 'Describe what happened'. Clinicians tended to deploy narrative to structure their accounts. Narratives, some have argued, 'act on the soul'. These forms of incident reporting therefore are more than an administrative formality: they are 'a technique of the self'.
Iedema, R., Flabouris, A., Grant, S., & Jorm, C.M. (2006). Narrativizing errors of care: critical incident reporting in clinical practice. Social Science & Medicine, 62(1), 134-144.
Iedema, R. (2007 [2005]). Critical incident reporting and the reconstitution of clinical identity. Journal of Applied Linguistics, 2(3), 343-364.