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Title: The culture of a Middle Eastern, multicultural healthcare institution and how it facilitates patient safety
Author: Tuite, Helena
Awarding Body: University of Ulster
Current Institution: Ulster University
Date of Award: 2012
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A movement to promote patient safety as a priority has gained momentum globally over the past 12 years. 2004 witnessed the World Health Organisation launching the World Alliance for Patient Safety and from its inception included representation from the Arab Gulf States. World Health Organisation's priorities for patient safety research puts identification, development and testing of locally effective solutions as a number one priority for the developing countries, as little epidemiology exists. Reporting of medical errors is a key mechanism of patient safety. To identify local solutions to the global problem of gross underreporting of medical errors and near misses, the culture of an organization needs to be understood first. The uniqueness of the Middle Eastern healthcare institution and the richness of its cultural diversity with less than 6% of its healthcare providers from the indigenous workforce, add complexity to the promotion of patient safety. This thesis presents and discusses findings of a study exploring how the culture of a multicultural Middle Eastern healthcare institution facilitates patient safety. The aim of the study is to determine how the culture facilitates patient safety and its objectives are to: use an ethnographic approach to gain a greater understanding of how registered nursing staff makes sense of patient safety; use of discourse analysis approach to make sense of power within this organization. The conceptual framework is based on an adaptation of Schein's organizational culture assessment model informed by discourse analysis influenced by the French philosopher Michel Foucault's approach to governmentality, to provide for a micro and macro level analysis of the study. Underpinning Schein's model is the theory that culture can be analysed at three different levels and by separating these levels, i.e. artefact, espoused values and basic assumptions, or at the taken for granted level, one can assess the 'essence of culture'. Governmentality is about how we think about guiding ourselves or others in any number of situations. Foucault's main interest in this regard lies in using history, i.e. genealogy, to show how things have become taken for granted, in the present, illuminating the fragility of the perceived perfect order, focused on power relations. This thesis is presented in 8 chapters. Data were generated from 622 hours of non-participant observation, detailed and highly descriptive field notes, reflexive diaries, transcripts, documents, archival search and open ended, semi-structured interview and informal conversations. Data were analysed under the three levels of the conceptual framework and a separate analysis was conducted by using a topography approach and a simple theoretical framework, with the same database, to provide for the history of the present. The findings provide a story of the lived culture through a description of the artefacts and espoused values and an interpretation of the basic assumptions in their attempt to characterise the essence of the culture of this organization that allows those expressed values that have become normalised. Exploring the global, regional and local discourses of patient safety provides us with an historical gaze that sees how the winds of change swept through this developing country in early 2000. The two key findings include: The routine non-conformity with set standards and patient safety related policies originate from the interconnectedness between the organization's adaptation to its external environment and the internal relationship among its group members. The unintended consequences of the subsequent strategiC position of changing the vision focus, to becoming internationally recognised for healthcare excellence through accreditation, has led to internal and external regulatory and disciplinary technologies and the subsequent inherent resistive actions. The discussion focuses on these key findings and brings together and reflects upon the various other findings of the study. The findings are discussed and interpreted in relation to the currently available literature. Implications for further research for these findings are proposed in conclusion.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available