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Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error

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  • Iedema, Roderick Aren Michael
  • Jorm, Christine
  • Long, Debbi
  • Braithwaite, Jeffrey
  • Travaglia, Jo
  • Westbrook, Mary

Abstract

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is anchored in the principle of health care practitioners not just scrutinizing each other, but scrutinizing each others' errors, RCA is a challenging task. Second, thanks to turning the clinical gaze in on the clinical observer, RCA engenders a new level of reflexivity of clinical self and of clinical practice. We conclude with asking whether this reflexivity will lock the clinical gaze into a micro-sociology of error, or whether it will enable this gaze to influence matters superordinate to the specifics of practice and the design of clinical treatments; that is, the over-arching governance and structuring of hospital care.

Suggested Citation

  • Iedema, Roderick Aren Michael & Jorm, Christine & Long, Debbi & Braithwaite, Jeffrey & Travaglia, Jo & Westbrook, Mary, 2006. "Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error," Social Science & Medicine, Elsevier, vol. 62(7), pages 1605-1615, April.
    • Handle: RePEc:eee:socmed:v:62:y:2006:i:7:p:1605-1615
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    References listed on IDEAS

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    1. Ong, L. M. L. & de Haes, J. C. J. M. & Hoos, A. M. & Lammes, F. B., 1995. "Doctor-patient communication: A review of the literature," Social Science & Medicine, Elsevier, vol. 40(7), pages 903-918, April.
    2. Williams, Simon J. & Calnan, Michael, 1996. "The 'limits' of medicalization?: Modern medicine and the lay populace in 'late' modernity," Social Science & Medicine, Elsevier, vol. 42(12), pages 1609-1620, June.
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    1. Iedema, Roderick Aren Michael & Jorm, Christine & Braithwaite, Jeffrey & Travaglia, Jo & Lum, Martin, 2006. "A root cause analysis of clinical error: Confronting the disjunction between formal rules and situated clinical activity," Social Science & Medicine, Elsevier, vol. 63(5), pages 1201-1212, September.
    2. Zuiderent-Jerak, Teun & Strating, Mathilde & Nieboer, Anna & Bal, Roland, 2009. "Sociological refigurations of patient safety; ontologies of improvement and 'acting with' quality collaboratives in healthcare," Social Science & Medicine, Elsevier, vol. 69(12), pages 1713-1721, December.
    3. Bradley, Eleanor & Hynam, Brian & Nolan, Peter, 2007. "Nurse prescribing: Reflections on safety in practice," Social Science & Medicine, Elsevier, vol. 65(3), pages 599-609, August.
    4. Josje Kok & Ian Leistikow & Roland Bal, 2019. "Pedagogy of regulation: Strategies and instruments to supervise learning from adverse events," Regulation & Governance, John Wiley & Sons, vol. 13(4), pages 470-487, December.
    5. Nicolini, Davide & Waring, Justin & Mengis, Jeanne, 2011. "Policy and practice in the use of root cause analysis to investigate clinical adverse events: Mind the gap," Social Science & Medicine, Elsevier, vol. 73(2), pages 217-225, July.

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