Management of organisational crises and patient safety: towards a more inclusive approach

The overall aim of the thesis is to realise a better, more holistic understanding of the management of smouldering crises and progress knowledge regarding the ‘latent conditions’ which underlie adverse patient safety incidents in healthcare organisations. In so doing, this thesis will move the debate concerning both the management of smouldering crises and patient safety in healthcare The dominant approach in crisis management theory has been to consider crises from an organisational perspective. In spite of more recent developments in the understanding of smouldering crisis which causally attribute the emerging crisis to limitations in management’s perspective, knowledge and capabilities, there has been insufficient emphasis upon understanding the contributory behaviour of grassroots level. Furthermore, whilst theory is empirically based, this has almost exclusively been founded on narratives offered by those who occupy senior management positions at the expense of considering employees who are closer to the crisis incubation point. Errors in medicine are rare. However, the consequences of adverse patient safety incidents can be devastating. In the healthcare sector, legislative and policy initiatives in the UK during the early part of this century placed patient safety high on the agenda. Consistent with the dominant paradigm in crisis management theory, systemic human error is seen to underpin adverse patient safety incidents. However, whilst progress has been made developing an understanding and addressing aspects of the causal route to such incidents through ‘latent conditions’, the degree of understanding regarding contributory behavioural factors has been more limited. This thesis rebalances the approach taken to date in the crisis management and patient safety literature by looking at smouldering crises from a less limited perspective than previously. It does so by exploring the views of individuals at grassroots level within an organisation. Adopting a qualitative research methodology and through purposive sampling, the research study utilises typical patient care scenarios in order to explore and understand the behaviour of employees in their workplace. The accounts of participants’ working life are examined using narrative analysis and the findings are crystallised in the author’s model of professional workplace behaviour, the ‘Faces of Self’. The author asserts that the limitations of management perspective, knowledge and capabilities which are responsible for the escalation of smouldering crises can be ameliorated if management are sensitive to and effective in the management of the organisation’s climate. In addition, effective improvement of both ‘hard’ and ‘soft’ ‘latent conditions’ by policy makers, leaders within organisations and management generally will create a more effective, motivated and satisfied healthcare professional in the patient care setting and negate some of the conditions in which the adverse patient safety incidents promulgate.