When the safety discourse changes

Who is currently moving the Swedish patient safety discourse forward? Scientists? Politicians? The National Board of Health and Welfare? Patients? Below I will argue non of these. Instead I will argue for a Swedish patient safety discourse currently changing rapidly thanks to nurses, doctors and journalists. For the better? I will not make that call. At least not explicitly.

What is happening in Sweden at the moment is that the healthcare system in several regions go through a severe crisis. The explanatory accounts are many and interesting (we pay too little tax, the primary care is too limited in relation to the specialist care, the system just need to implement some lean production to become more efficient, with private care funded by tax money the tax money is actually transformed into profit leaving the country, etc.). Most stakeholders seem to agree that there are more patients than there are beds available, but the causal accounts are diverse.

What I find interesting in this challenging (and sometimes seemingly desperate) situation is the (exponentially increasing?) use of the patient safety label. From not being a part of the language of health care practitioners some ten years ago it is now the central notion for the people on the shop floor (mainly nurses) to make their voices heard in the public dialogue and debate. The way to make a case for how desperate the situation is in Swedish healthcare institutions is currently through the use of a patient safety discourse.

Look what happens when I just (really non-scientifically) google "patient safety AND threatened" (I do this in Swedish: "patientsäkerheten hotad"). What I get is nurses and doctors claiming that the current situation threatens patient safety in regions across the entire country. Below are just some (recent) examples:

Stockholm: Debate article written by six doctors, published in the main Swedish morning newspaperArticle in the same main Swedish morning newspaper

The southern region (Skane) where I live: Press release at the Swedish Association of Health Professionals,  Article published in the news paper Skånskan

Blekinge: Article published in the newspaper Blekinge läns tidning

Gotland: Article published in the newspaper Hela Gotland

Småland: Regional TV news broadcast

Norrland: Regional TV news broadcast

Gävleborg: Article in the healthcare oriented paper Vårdfokus

Sörmland: Article at the (nursing oriented) webpage dagens sjuksköterskaand Debate article in the local newspaper Eskilstunakuriren

Värmland: Regional TV news broadcast

These are just a few examples of recent articles and news clips across Sweden. The two words "patientsäkerhet" and "hotad" in combination gives 6850 hits on google just in the last 12 months and 3060 in the last month - quite a trend!

The accounts from doctors and nurses that the current situation threatens patient safety have had impact on the most influential news broadcasts in Sweden, like here at the weekly news analysis TV broadcast Agenda.

I find this trend absolutely fascinating.

Not only nurses and doctors are making their voices heard. Journalists have lately written thorough analyses of the current situation. Maciej Zaremba's recent article series on the Swedish healthcare system, published in the main Swedish morning newspaper DN, has been given huge attention (http://www.dn.se/kultur-noje/vad-var-det-som-dodade-herr-b) and Anna Ritter last week made the argument in the Swedish weekly magazine Fokus that the problem is not the number of beds per se but the balance between primary care and specialist care (http://www.fokus.se/2013/02/sjukhussjukan/).

What I also find fascinating is the current gap in how nurses and doctors are currently using a discourse of patient safety to make their voices heard and the way in which "patient safety tools" are used in their system. While nurses and doctors are using the discourse to point towards macro problems of resource allocation and the inability to treat the number of patients in need using the number of beds available, pointing at political reasons, the conclusions in the incident/accident analyses conducted at Swedish hospitals are still pointing towards micro features of routines and communication.

Can it be so that the currently promoted method for incident/accident investigations in the Swedish healthcare system is merely a ritual for forgetting and moving on? For creating an argument for micro control? And are we, who are doing research on the topic of patient safety, any better? Or are we also promoting the micro level interventions using for example Global Trigger Tools to find signs of committed errors in patient files, incident analysis methods based on linear root cause thinking and safety culture surveys in order to conclude that shop floor staff find it easier to cooperate within the walls of the ward than across wards?

If so, the shop floor staff is currently challenging this discourse with a really interesting new take. Or have they simply just hijacked the discourse for their whining? 


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