Infections and Interaction Rituals: A Microsociological Reinterpretation of Speaking up for Safety in Hospitals

• In Event: 124 - Regular Session. Illness Experience and Health Care Delivery in Hospitals: Insights from Ethnographic Research

Abstract

Clinician silence in the face of known threats to safety is a source of growing concern. Interventions drawn from other industries encourage clinicians to “speak up for safety” when they observe a breach in practice. Despite considerable effort by patient safety reformers, it remains difficult for clinicians to speak up. Current explanations are typically conceptualised at the individual and organisational level. These explanations cannot account fully for the challenges of speaking up because they ignore the interaction context in which healthcare is delivered. Drawing on 103 interviews with clinicians gathered during a 2 year ethnographic study of one hospital in the United States as it implemented a program to reduce hospital-acquired infections, this article reinterprets “speaking up for safety” using a microsociological lens. It identifies three mediating factors that influence the decision to speak up: mutual focus of attention, interactional path dependence, and the presence of an audience. The decision to speak up or remain silent in any one moment in a clinical setting is dynamic, highly context-dependent and embedded in the interaction rituals that suffuse everyday work. This article highlights the analytic leverage that can be gained by recoupling patient safety techniques to the microdynamics of social interaction.

Author

• Julia E. Szymczak, The Children's Hospital of Philadelphia