Safety and complexity: the inter-departmental threats to patient safety in the operating department

Purpose: Current thinking about ‘patient safety’ emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of Normal Accidents to extend this analysis and better understand the ‘organisational factors’ that threaten safety. Methods: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. Results: The work of the operating department is determined by inter-dependant, ‘tightly coupled’ organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as ‘breakdowns’ within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. Conclusion: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured ‘real world’ situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.

Beyond Blame: cultural barriers to medical reporting

The paper explores the attitudes of medical physicians towards adverse incident reporting in health care, with particular focus on the inhibiting factors or barriers to participation. It is recognised that there are major barriers to medical reporting, such as the ‘culture of blame’. There are, however, few detailed qualitative accounts of medical culture as it relates to incident reporting. Drawing on a 2-year qualitative case study in the UK, this paper presents data gathered from 28 semi-structured interviews with specialist physicians. The findings suggest that blame certainly inhibits medical reporting, but other cultural issues were also significant. It was commonly accepted by doctors that errors are an ‘inevitable’ and potentially unmanageable feature of medical work and incident reporting was therefore ‘pointless’. It was also found that reporting was discouraged by an anti-bureaucratic sentiment and rejection of excessive administrative duties. Doctors were also apprehensive about the increased potential for managers and non-physicians to engage in the regulation of medical quality through the use of incident data. The paper argues that the promotion of incident reporting must engage with more than the ubiquitous ‘culture of blame’ and instead address the ‘culture of medicine’, especially as it relates to the collegial and professional control of quality.

New ethnicities online: reflexive racialisation and the internet

In this article we analyse the emergence of Internet activity addressing the experiences of young people in two British communities: South Asian and Chinese.We focus on two web sites: www.barficulture.com and www.britishbornchinese.org.uk, drawing on interviews with site editors, content analysis of the discussion forums, and E-mail exchanges with site users. Our analysis of these two web sites shows how collective identities still matter, being redefined rather than erased by online interaction. We understand the site content through the notion of reflexive racialisation. We use this term to modify the stress given to individualisation in accounts of reflexive modernisation. In addition we question the allocation of racialised meaning from above implied by the concept of racialisation. Internet discussion forums can act as witnesses to social inequalities and through sharing experiences of racism and marginalisation, an oppositional social perspective may develop. The online exchanges have had offline consequences: social gatherings, charitable donations and campaigns against adverse media representations. These web sites have begun to change the terms of engagement between these ethnic groups and the wider society,and they have considerable potential to develop new forms of social action.

Inclusion, Participation and the Emergence of British Chinese Websites

Previous work has drawn attention to the relative absence of British Chinese voices in public culture. No one is more aware of this invisibility than British-born Chinese people themselves. Since 2000 the emergence of Internet discussion sites produced by British Chinese young people has provided an important forum for many of them to grapple with questions concerning their identities, experiences and status in Britain. In this paper we explore the ways in which Internet usage by British-born Chinese people has facilitated forms of self-expression, collective identity production and social and political action. This examination of British Chinese websites raises important questions about inclusion and exclusion, citizenship, participation and the development of a sense of belonging in Britain, issues which are usually overlooked in relation to a group which appears to be well integrated and successful in higher education.

Ethnicity, Social Capital and the Internet

This article explores web sites developed to express the interests and experiences of young Chinese people in Britain. Drawing on content analysis of site discussions and dialogues with site users, we argue these new communicative practices are best understood through a reworking of the social capital problematic. Firstly by recognising the irreducibility of Internet-mediated connections to the calculative instrumentalism underlying many applications of social capital theory. Secondly, by providing a more differentiated account of social capital. The interactions we explore comprise a specifically “second generation” form of social capital, cutting across the binary of bonding and bridging social capital. Thirdly judgement on the social capital consequences of Internet interactions must await a longer-term assessment of whether British Chinese institutions emerge to engage with the wider polity.

Social Policy and Time

Time is crucial to the implementation, operation and effectiveness of social policies, yet the subject has often treated the meaning of time as theoretically unproblematic. It focuses more upon what policies do and less upon the contexts within which the practices and assumptions of social actors are embedded. The article offers a more sophisticated theoretical account of time upon which is based an exploration of the main temporal features of welfare capitalism. It then goes on to examine three recent and prominent research projects in order to show how and why they fail to incorporate a convincing social theory of time.

European Cosmopolitanism and Civil Society

The discussion of European cosmopolitanism and civil society has failed to take questions of culture seriously enough. While remaining sympathetic to liberal forms of cosmopolitanism, this article considers the view that such proposals fail to make space for the 'Other'. In the context of histories of nationalist violence, masculinism and consumerism this article discusses the charge that ideas of European civilization need to be reconsidered. In the final part of the article, I discuss the view that cultural feminism and certain versions of multiculturalism have much to contribute towards the European project. However, at this point, I seek to distance myself from essentialist arguments in respect of identity. A generative European cosmopolitanism would do well to take questions of cultural domination seriously without reducing the complexity of modern identities.

European Cosmopolitan Solidarity

The idea of a cosmopolitan Europe continues to be central to contemporary debates within post-national citizenship. However, much of the writing in this area remains disconnected from the need to reinvent European social democracy that questions the centrality of work and racist nationalism. This article argues that a revived European Left would need to move beyond specifically liberal concerns with procedure to articulate a view of European futures that both deconstructed neo-liberalism and embraced more convivial collective futures. This would entail the combination of a post-material politics that sought to critique the centrality of employment while granting citizens a basic income or forms of civic labour and a more concerted attempt to break with a racialized politics based upon the fear of the ‘Other’. In conclusion, it is argued that the urgent political task of the future is to reinvent a sense of Europeaness that has both a substantive content, but that does not become mobilized by an exclusive cultural politics.

Queering religious texts: An exploration of British non-heterosexual Christians’ and Muslims’ strategy of constructing sexuality-affirming hermeneutics.

Religious authority figures often use religious texts as the primary basis for censuring homosexuality. In recent years, however, non-heterosexual Christians and Muslims have begun to contest the discursively produced boundary of sexual morality.Drawing upon two research projects on non-heterosexual Christians and Muslims, this article explores the three approaches embedded in this strategy.While acknowledging that homosexuality is indeed portrayed negatively in some parts of religious texts, the participants critique traditional hermeneutics by highlighting its inaccuracy and socio-cultural specificity, and arguing for a contextualized and culturally relevant interpretation. They also critique the credibility of institutional interpretive authority by highlighting its inadequacy and ideology, and relocating authentic interpretive authority to personal experience. Finally, they recast religious texts to construct resources for their spiritual nourishment.This strategy generally reflects the contemporary western religious landscape that prioritizes the authority of the self over that of religious institution.

Policy Implications of Ageing Sexualities

This article aims to open up debate on the policy implications of ageing sexualities. The article begins by discussing the heteronormative perspective that frames current discourse on older people’s needs and citizenship. It then presents data from an empirical study to highlight the concerns that older lesbians and gay men have about housing, health and social service provision, work and job security, and relationship recognition. The article illustrates how the heterosexual assumption that informs policy making can limit the development of effective strategies for supporting older lesbians and gay men; and raises broader questions about policy making, social inclusion and citizenship.

Ageing in a non-heterosexual context.

There is increasing recognition of the importance of social and cultural differences in shaping the diversity of the ageing experience in contemporary Britain. Various social and cultural factors, such as those associated with class, ethnicity, gender and disability, influence people’s living circumstances and sources of support in later life. While they have been the subject of considerable speculation, ageing in a non-heterosexual context remains remarkably under-studied. This paper examines the difference that being non-heterosexual makes to how people experience ageing and later life. It draws on quantitative and qualitative data gathered for a British study of the living circumstances of non-heterosexuals aged between the fifties and the eighties. Previous work has overwhelmingly emphasised how individuals manage their sexual identities, but this paper focuses on the factors that shape the non-heterosexual experience of ageing and later life. Particular attention is paid to the relational and community contexts in which non-heterosexuals negotiate personal ageing. This not only provides insights into the specific challenges that ageing presents for non-heterosexuals, but also offers insights into the challenges faced by ageing non-heterosexuals and heterosexuals in ‘ detraditionalised ’ settings.