Doctors' thinking about the system as a threat to patient safety

‘Systems thinking’ is an important feature of the emerging ‘patient safety’ agenda. As a key component of a ‘safety culture’, it encourages clinicians to look past individual error to recognise the latent factors that threaten safety. This paper investigates whether current medical thinking is commensurate with the idea of ‘systems thinking’ together with its implications for policy. The findings are based on qualitative semistructured interviews with specialist physicians working within one NHS District General Hospital in the English Midlands. It is shown that, rather then favouring a 'person-centred’ perspective, doctors readily identify ‘the system’ as a threat to patient safety. This is not necessarily a reflection of the prevailing safety discourse or knowledge of policy, but reflects a tacit understanding of how services are (dis)organised. This line of thinking serves to mitigate individual wrong-doing and protect professional credibility by encouraging doctors to accept and accommodate the shortcomings of the system, rather than participate in new forms of organisational learning.

Carbon gold rush and carbon cowboys: a new chapter in green mythology?

Individual and collective efforts to mitigate climate change in the form of carbon offsetting and emissions trading schemes have recently become the focus of much media attention. In this paper we explore a subset of the UK national press coverage centered on such schemes. The articles, selected from general as well as specialized business and finance newspapers, make use of gold rush, Wild West and cowboy imagery which is rooted in deeply entrenched myths and metaphors and allows readers to make sense of very complex environmental, political, ethical, and financial issues associated with carbon mitigation. They make what appears complicated and unfamiliar, namely carbon trading and offsetting, seem less complex and more familiar. A critical discussion of this type of imagery is necessary in order to uncover and question tacit assumptions and connotations which are built into it and which might otherwise go unnoticed and unchallenged in environmental communication.