Huw Davies

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Huw Davies

• Professor of Health Care
• Policy Management
• Director
• Social Dimensions of Health Institute (SDHI)
• Universities of St Andrews Dundee
• Taking an Organisational Perspectiveon Patient
  Safety

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at the Universities of Dundee and St Andrews

• SDHI and Patient Safety Research
• Linking the clinical and the social sciences
• in innovative interdisciplinary research
• in partnership with health care professionals.
• To explore -
• - the social dimensions of health/ill health
  and
• - social/organisational aspects of service
  delivery.
• Generating knowledge for policy/practice
  influence.

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Contributing to the Patient Safety Research
Network
Human and Organisational Factors Contributing to
Adverse Events Huw Davies, Peter Davey, Rhona
Flin, Martyn Jones, Lorna McKee, Katherine
Mearns, Rosemary Rushmer et al.
St Andrews
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Why care about organisations?

• The major determinant of our care quality is the
  systems through which services are delivered -
  and not the individual care provider.
• Lagasse et al, 1995

?
Context Matters Its situational not
dispositional!
?
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Systems Model for Adverse Events
Dynamic alignment
but also opportunities for near misses and system
failures
Reason 1997
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Some Organisational Themes

• Organisational Culture and Climate
• Initiating Change and Improvement
• Embedding, Sustaining and Spreading beneficial
  change
• Leadership roles, behaviours, impacts
• Role change and professional boundaries

Organisations form the context for health care --
and hence the context for adverse events
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Mechanistic or social view on organisations?

• Organisations as rational, instrumental,
  mechanistic agencies emotionless arrangements
  for getting things done
• Organisations as values-infused mini-societies
  driven by social dynamics, and concerned with
  meaning, power and emotion.

- or -
Leadership in Administration (Selznick 1957)
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Socialisation of new staff
(its situational not dispositional)
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Organisational culture
The way things are done around here

• That which is shared within organisations
• beliefs, values, attitudes, norms of behaviour
• routines, traditions, ceremonies, rewards
• meanings, narratives and sense-making
• across all, or across significant sub-groups.
• Helps define legitimacy and acceptability
• A kind of social and normative glue,
  enabling and constraining performance.

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Cultures matter - but can we manage them?
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The Importance of Leadership

• The unique and essential function of leadership
  is the manipulation of culture.

Schein, 1985
Need to think more of spheres of influence - and
distributed leadership behaviours - rather than
leadership traits or formal leadership
positions.
POWER The fundamental concept in social
science is power, in the same sense in which
energy is the fundamental concept in physics.
(Bertrand Russell)
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Professional roles who is and who does?

• Staffing staff ratios skill-mix substitution
• The professions, identity and interface -

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The Social Dimensions of Safety -

• Sees individual behaviour as -
• embedded in dynamic networks of human relations -
  including relations with patients
• in organisations that have relevant histories,
  and that are in a constant process of being
  interpreted
• where behaviour is facilitated andconstrained by
  the structures, resources and cultural norms of
  local social networks
• where the drivers are moral and social, as well
  as material.

Granovetter, 1992