Narrativizing Errors of Care : Critical Incident Reporting in Clinical Practice  

Oleh:

Iedema, Rick ; Flabouris, Arthas ; Grant, Susan ; Jorm, Christine

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 62 no. 1 (Jan. 2006), page 134-144.
Topik: care; critical incident reporting; adverse event; narrative; acute care; discourse genre; self identity

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.1 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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This paper considers the rise across acute care settings in the industrialized world of techniques that encourafe clinicians to record their experiences about advesr events they are personally involved, that is to share narratives abour errors, mishaps or critical incidents. The paper proposes that critical incident reporting and the root cause investigations it affords, are both central to the effort to involve clinicans in managing and organizing their work and a departure from established methods and approaches to achieve clinicians; involvement in these non clinical domains of health care. We argur that critical incident narratives render visible details of the clinical work that have thus far only been discussed in closed, paperless meetings, and that as narratives they inicte individuals to share personal experiences with parties previously excluded from knowledge about failure. Drawing on a study of 124 medical retrieval incident reports, the paper provides illustrations and interpretations of both the narrative and the meta discursive dimensions of critical incident reporting. We suggest that as a new and complex genre, critical incident reporting achieves three important objectives. First it provides clinicians with a channel for dealing with incidents in a way that bring problems to light in a non blaming way and that might therefore be morally satisfying and perhaps even therapeutic. Second, these narrations make available new spaces for the apprehension, identification and performance of self. Here the incident report becomes a space where clinicians publicly perform concern about what happened. Third, incident reporting becomes the basis for radically altering the clinician organization relationship. As a complex expression of clinical failure and its re articulation into organizational meta discourse, incident reporting puts doctors' selves and feelings at risk not just within the relative safety of personal or intra professional relationships, but also i the normative context of organizational coordination, accountability, planning and management.

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