https://doi.org/10.4081/qrmh.2023.11496
A narrative journey into the borderland of patient safety: Toward an expanded, relational concept of safety
Submitted: 30 May 2023
Accepted: 24 December 2023
Published: 16 January 2024
Accepted: 24 December 2023
Abstract Views: 764
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
“Patient safety” is routinely defined in health services globally as “safety for patients against harm and risk of injury in health care.” (Danish Board of Quality in Health Care, 2022, p. 28; translated by the author). This is a standardized, broad, and general definition of what counts as safety. In this article, I argue for an expanded, relational concept of patient safety revolving around experienced patient safety. Recognizing safety as vital for all groups of patients, I follow a dialogical, critical-reflexive approach to focus on safety in a somatic hospital setting in Denmark as it is experienced by people with lived experience of mental distress. Safety in this context is often compromised, contributing to inequity in health for people with mental distress. I present and analyze the narratives of two experts by experience about their somatic hospital stay. As an analytical approach, I draw on Frank’s dialogical narrative analysis together with elements from Bakhtin’s theory of dialogue and Foucault’s theory of power/knowledge. Forefronting voices of those rarely asked and seldom heard, dialogical narrative analysis provides insight into how “patient safety” is enacted through situated negotiations of meaning in the narratives of people with lived experience. The storytellers are continuously struggling to fit in and to be seen as human beings, trying to resist public narratives on mental distress that threaten to limit their scope of action and who they can become. The discussion highlights how unintended emotional and psychosocial harm limit the benefits of patient safety for certain groups in society. In particular, shame, individualized responsibility, and internalized inferiority hinder equity in health. Building on my analysis, I suggest a collaborative, participatory approach for coproducing further knowledge through joint analysis with people with lived experience and nurses from somatic hospital wards.
Bach, K. F. (2020, August 19). Happy pride week! Let’s have equity in health for LGBT+ [Glædelig pride uge! Lad os så få lighed i sundhed for LGBT+]. Danish Society for Patient Safety. https://patientsikkerhed.dk/glaedelig-pride-uge-lad-os-saa-faa-lighed-i-sundhed-for-lgbt/
Bakhtin, M. (1981). The dialogic imagination. Four Essays. University of Texas Press.
Bakhtin, M. & Emerson, C. (1984). Problems of Dostoevsky’s poetics. University of Minnesota Press.
DOI: https://doi.org/10.5749/j.ctt22727z1
Belin, S. (1999). The power of madness [Galskabens magt]. Hans Reitzel.
Berring, L. L., Pedersen, L., & Buus, N. (2015). Discourses of aggression in forensic mental health: A critical discourse analysis of mental health nursing staff records. Nursing Inquiry, 22(4), 296–305.
DOI: https://doi.org/10.1111/nin.12113
Blix, B. H., Hamran, T., & Normann, H. K. (2013). Struggles of being and becoming: A dialogical narrative analysis of the life stories of Sami elderly. Journal of Aging Studies, 27(3), 264–275.
DOI: https://doi.org/10.1016/j.jaging.2013.05.002
Christensen-Strynø, M. B., Phillips, L., & Frølunde, L. (2021). Revitalising sensualities of ageing with Parkinson’s through dance. Journal of Aging Studies, 59, 1–10.
DOI: https://doi.org/10.1016/j.jaging.2021.100978
Danish Board of Quality in Health Care. (2022) Quality Guide [Kvalitetsguiden]. Retrieved 25 August 2023, from https://dsks.dk/kvalitetsguiden-dk/
Danish Patient Safety Authority. (2018). Help us improve [Hjælp os med at blive bedre]. Flyer. Retrieved 25 August 2023. Available from https://stps.dk/da/laering/utilsigtede-haendelser/
Danish Patient Safety Authority. (2022). Danish patient safety database annual report 2021 [Dansk patientsikkerhedsdatabase årsrapport 2021]. Retrieved 25 August 2023. Available from https://stps.dk/da/udgivelser/2022/aarsberetning-for-dansk-patientsikkerhedsdatabase-2021/
Daumit, G. L., McGinty, E. E., Pronovost, P., Dixon, L. B., Guallar, E., Ford, D. E., Cahoon, E. K., Boonyasai, R. T., & Thompson, D. (2016). Patient safety events and harms during medical and surgical hospitalizations for persons with serious mental illness. Psychiatric Services, 67(10), 1068–1075.
DOI: https://doi.org/10.1176/appi.ps.201500415
Declaration of Health Law 08/03/2023, Pub. L. No. 248 (2023). Retrieved 25 August 2023 from https://www.retsinformation.dk/eli/lta/2023/248
Foucault, M. (1991). Governmentality. In G. Burchell, C. Gordon, & P. Miller (Eds.), The Foucault effect (pp. 87–104). University of Chicago Press.
Frank, A. W. (2005). What is dialogical research, and why should we do it? Qualitative Health Research, 15(7), 964–974.
DOI: https://doi.org/10.1177/1049732305279078
Frank, A. W. (2010). Letting stories breathe: a socio-narratology. The University of Chicago Press.
DOI: https://doi.org/10.7208/chicago/9780226260143.001.0001
Frank, A. W. (2012). Practicing dialogical narrative analysis. In J. A. Holstein & J. F. Gubrium (Eds.), Varieties of narrative analysis (pp. 33–51). Sage.
DOI: https://doi.org/10.4135/9781506335117.n3
Frank, A. W. (2013). The wounded storyteller. (2nd ed.). University of Chicago Press.
Frank, A. W. (2016). From sick role to narrative subject. Health, 20(1), 9–21.
DOI: https://doi.org/10.1177/1363459315615395
Harris, B., Beurmann, R., Fagien, S. & Shattell, M. M. (2015). Patients’ experiences of psychiatric care in emergency departments: A secondary analysis. International Emergency Nursing, 26 (2016) 14–19.
DOI: https://doi.org/10.1016/j.ienj.2015.09.004
Health.dk. (2018). Report an unintended incident. https://www.sundhed.dk/borger/behandling-og-rettigheder/klage-og-erstatning/rapporter-utilsigtede-haendelser/
Høgsgaard, D. (2018). Narratives as co-production method in cross-sectoral health care collaboration [Fortælling som metode til samskabelse i det tværsektorielle samarbejde i sundhedsvæsenet]. In B. R. Olesen, L. Phillips, & T. L. Johansen (Eds.), Dialogue and co-production [Dialog og samskabelse] (pp. 121–139). Akademisk Forlag.
Holstein, J. A., & Gubrium, J. F. (2011). Animating interview narratives. In Qualitative Research: Issues of Theory, Method, and Practice (pp. 149–167). Sage Publications.
Hor, S., Godbold, N., Collier, A., & Iedema, R. (2013). Finding the patient in patient safety. Health, 17(6), 567–583.
DOI: https://doi.org/10.1177/1363459312472082
Iedema, R. (2011). Creating safety by strengthening clinicians’ capacity for reflexivity. BMJ Quality & Safety, 20(Suppl 1), i83–i86.
DOI: https://doi.org/10.1136/bmjqs.2010.046714
Jacobsen, C.B., Martin, H. M., Andersen, S. L., Christensen, R. N., & Bengtsson, S. (2010). Stigma and mental health disorders [Stigma og psykiske lidelser]. The national welfare research centre. Retrieved 25 August 2023 from https://www.vive.dk/media/pure/4419/273339
Jørgensen, C. R. (2023). Shame [Skam]. Hans Reitzels Forlag.
Kuzel, A. J., Woolf, S. H., Gilchrist, V. J., Engel, J. D., LaVeist, T. A., Vincent, C., & Frankel, R. M. (2004). Patient reports of preventable problems and harms in primary health care. Annals of Family Medicine, 2(4), 333–340.
DOI: https://doi.org/10.1370/afm.220
Lyndon, A., Davis, D., Sharma, A.E., & Scott, K.A. (2023). Emotional safety is patient safety. BMJ Quality & Safety, 2023;0:1–4.
Løgstrup, K. E. (1956). The ethical demand [Den etiske fordring]. Gyldendal.
Morse, L., & Richards, J. M. (2013). Readme first for a user’s guide to qualitative methods. Sage.
DOI: https://doi.org/10.4135/9781071909898
One of Us. (n.d.). One Of Us Toolkit/Image Association Exercise [En af Os Værktøjskasse/Billedassociation]. Retrieved 18 April 2023, from http://www.en-af-os.dk/da/Materialer/Vaerktoejskasser/Start-Dialogen---i-socialpsykiatrien/Kom-godt-i-gang
Pedersen, C. H. (2021). Crafting collaborative research methodologies. Routledge.
DOI: https://doi.org/10.4324/9781003126980
Phillips. L. (2011) The promise of dialogue. John Benjamins Publishing Company
DOI: https://doi.org/10.1075/ds.12
Phillips, L., & Scheffmann-Petersen, M. (2020a). Minding the gap between the policy and practice of patient-centredness. Qualitative Health Research, 30(9), 1419–1430.
DOI: https://doi.org/10.1177/1049732320913855
Phillips, L., & Scheffmann‐Petersen, M. (2020b). Unpacking “patient‐centredness”: how knowledge is negotiated dialogically in the interweaving of genres and voices in counselling conversations. Sociology of Health & Illness, 42(6), 1456–1472.
DOI: https://doi.org/10.1111/1467-9566.13118
Reeves, E., Henshall, C., Hutchinson, M., & Jackson, D. (2018). Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: A systematic review. International Journal of Mental Health Nursing, 27(1), 46–60.
DOI: https://doi.org/10.1111/inm.12426
Rexbye, H., & Frappart, H. S. (2022). A historical perspective [Et historisk blik]. In H. Rexbye & H. S. Frappart (Eds.), Patient safety, unintended incidents, and risk management [Patientsikkerhed, UTH og risikostyring] (pp. 15–28). FADL’s Forlag.
Rhodes, P., McDonald, R., Campbell, S., Daker‐White, G., & Sanders, C. (2016). Sensemaking and the co‐production of safety. Sociology of Health & Illness, 38(2), 270–285.
DOI: https://doi.org/10.1111/1467-9566.12368
Roper, C., Stjernegaard, K., Kennedy, H., & Edan, V. (2021). Recovery. In N. Buus, B. Askham, L. L. Berring, L. Hybholt, K. Stjernegaard, & E. S. Tønder (Eds.), Mental health nursing [Psykiatrisk sygepleje] (2nd ed., pp. 23–55). Munksgaard.
Sokol-Hessner, L., Folcarelli, P. H., & Sands, K. E. F. (2015). Emotional harm from disrespect: The neglected preventable harm. BMJ Quality & Safety, 24(9), 550–553.
DOI: https://doi.org/10.1136/bmjqs-2015-004034
Travaglia, J. F., & Braithwaite, J. (2009). Analysing the ‘field’ of patient safety employing Bourdieusian technologies. Journal of Health Organization and Management, 23(6), 597–609.
DOI: https://doi.org/10.1108/14777260911001626
WHO. (2021). Global patient safety action plan 2021–2030. Towards eliminating avoidable harm in health care. Retrieved 25 August 2023. Available from https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
Yuval-Davis, N. (2006). Belonging and the politics of belonging. Patterns of Prejudice, 40(3), 197–214.
DOI: https://doi.org/10.1080/00313220600769331
How to Cite
Lauge Andersen, Lisbeth. 2024. “A Narrative Journey into the Borderland of Patient Safety: Toward an Expanded, Relational Concept of Safety”. Qualitative Research in Medicine and Healthcare 7 (3). https://doi.org/10.4081/qrmh.2023.11496.
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