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Title: 'Risk and resilience' : the mobilisation of professional knowledge in the creation of patient safety in anaesthetic practice : a reflexive interpretive synthesis of previously published work
Author: Smith, Andrew Fairley
ISNI:       0000 0004 6424 5349
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2016
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The patient safety ‘movement’ has relied largely on formal, explicit structures in attempting to promote principles and practices from safety-critical industries within the healthcare sector. The ‘craft’ nature of medical practice is however, predicated on the interplay of formal and tacit experiential knowledge. The specialty of anaesthesia is a branch of medicine and yet the nature of anaesthetic practice resembles operational work within e.g. aviation and nuclear power, sharing with them the characteristics of time pressure, complex human-machine interactions, uncertainty and risk. This thesis takes the form of an interpretive meta-synthesis of six published journal articles to examine how patient safety is constructed and enacted through the transmission and co-creation of professional knowledge. After delineating the forms of knowledge used in anaesthetic work, it describes how abstract notions of safety are expressed within a number of specific aspects of practice: the use of electronic monitoring equipment; communication between actors on induction of, and emergence from, general anaesthesia; the definition and analysis of adverse incidents; postoperative handover of care in the recovery room and in the performance of regional anaesthesia as an exemplar technical procedure. Anaesthetists draw both on informal logics and routines of practice and on codified safety knowledge and tools. How, and when, to reconcile these two approaches relies on a dynamic combination of cognitive, affective and normative influences, which seem to be embedded in anaesthetists’ professional identity. Paradoxically, much of this seems to be learned through contact with the very failure and error that the routines are designed to avoid and prevent; It is developed through dealing with the many perturbations and threats to the safety of their patients, whether through personal experience, the ‘cautionary tales’ of others, or imagining what might go wrong. The interpretive synthesis thus provides empirical support for theoretical notions of how resilience to error is created in everyday work in safety-critical settings.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available