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Title: Patient safety and employee voice : the role of second victims in overcoming the hierarchical challenge
Author: Richmond, John G.
ISNI:       0000 0004 7431 7262
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2018
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Healthcare organisations have struggled to improve safety. Over the last 20 years rates of patient harm have remained at around 10%, despite implementation of various improvement initiatives linked to the patient safety movement. This study identifies key conditions perpetuating this safety ‘implementation gap’: 1) a hierarchical challenge and 2) second victim phenomenon. Employee voice is adopted as a sensitising concept. The aim is to identify conditions which moderate the hierarchical challenge, encouraging the enactment of voice, leading to prevention of further medical errors. This PhD’s original contribution to knowledge is: second victims are key actors in attenuating hierarchical barriers through enactment of positively valenced practices. Adopting a practice-based approach identifying medical errors as break-downs in professional practice, three cases of serious medical error at a single NHS Trust are chosen for comparative analysis. Data collection includes over 100 hours of observations, 50 interviews, and review of 35 documents. Evidence for a climate of silence was found in each case stemming from: a hierarchical culture, blame culture, and futility of voice. Acquiescent or defensive silence contributed directly to each serious medical error. Second victims were found in each case, generally experiencing guilt, shame, anger, and compassion. The recovery trajectory of these second victims varied, with one ‘thriving’ while others ‘survived’ or ‘dropped out’. Positively valenced practice changes, which set the conditions for voice, were enacted by affectively charged individuals, either the second victim themselves, or through a process of emotional contagion, their colleagues. These conditions for voice included: setting expectations for voice, management engendering voice, closer adherence to policy and standard operating procedures, and a reinvigorated sentiment of care. These changes led to development of a voice climate encouraging the enactment of both defensive and prosocial voice. A safety incident model of voice for second victims was developed and transferability discussed.
Supervisor: Not available Sponsor: National Institute for Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: HD28 Management. Industrial Management ; RA Public aspects of medicine