Healthcare professionals’ understanding of patient safety: relevance to the development of person-centered medicine


  • Konstantinos Arfanis Research Fellow. Lancaster Patient Safety Research Unit, University Hospitals of Morecambe Bay Foundation NHS Trust, Lancaster, UK
  • Andrew Smith Consultant Anaesthetist and Director, Lancaster Patient Safety Research Unit, University Hospitals of Morecambe Bay Foundation NHS Trust, Lancaster, UK



Aims and Objectives: The success of patient safety initiatives in the development of person-centered models of clinical care depends on the engagement of ‘frontline’ clinical staff. However, little is known about how such staff understand and act on notions of risk and safety. We aimed to explore this understanding through qualitative inductive analysis of interview data from healthcare staff in an acute hospital. Method and Results: We interviewed 43 members of staff and analysed the interviews using a grounded theory approach. ‘Patient safety’ was understood within each participant’s own work context. We noted discrepancies in that understanding, with ‘vertical’ differences (variations in experience and seniority) within one professional group and ‘horizontal’ differences between groups. Risk was generally seen as intrinsic to daily working life. Participants focus on managing rather than trying to avoid risk. An informal but complex conceptualisation identified ‘professional’ and ‘situational’ risk. Participants also distinguished ‘acceptable’ from ‘unacceptable’ risk and ‘avoidable’ from ‘unavoidable’ risk. These contrasts seemed to help them decide whether it is feasible, necessary and/or beneficial to intervene when a risk appears. Further, different individuals and groups were recognized to have understanding and ‘ownership’ of specific risks or groups of risks.  Formal manifestations of safety systems, such as protocols and procedures, were recognised as useful, but concerns were expressed about the quantity and currency of protocols and about the difficulties caused by lack of resource.Conclusion: We suggest that an understanding of how health professionals deal informally with ideas about safety and risk should be used to shape and enhance formal safety initiatives in health services as an important contribution to the development of person-centered clinical care.


National Patient Safety Agency. (2004). Seven steps to patient safety:

Van der Schaaf, T.W. (2002). Medical applications of industrial safety science. Quality and Safety in Health Care 11, 205-206.

Shapiro, M.J., & Jay, G.D. (2003). High reliability organizational change for hospitals: translating tenets for medical professionals. Quality and Safety in Health Care 12, 238-239.

Flin, R., Burns, C., Mearns, K., Yule, S. & Robertson, E.M. (2006). Measuring safety climate in health care. Quality and Safety in Health Care 15, 109-115.

Tajfel, H. & Turner, J.C. (1986). The social identity theory of inter-group behavior. In: Psychology of Intergroup Relations. (eds. Worchel, S. & Austin, L.W.) Chicago: Nelson-Hall.

Turner, J.C., Hogg, M.A., Oakes, P.J., Reicher, S.D. & Wetherell, M.S. (1987). Rediscovering the Social group: A self categorization theory. Oxford, England: Blackwell.

Strauss, A. & Corbin, J. (2005). Grounded Theory methodology: An overview. In: Handbook of Qualitative Research (eds. Denzin, N.K. & Lincoln, Y.). London: Sage Publications.

Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications.

Smith, M. (2004). The paradox of the risk society state. British Journal of Politics and International Relations 6, 312-332.

Breakwell, G.M. (2007). The Psychology of Risk. Cambridge: Cambridge University Press.

MacDonald, R., Waring, J. & Harrison, S. (2005). ‘Balancing risk, that is my life’: The politics of risk in a hospital operating theatre department. Health Risk & Society 7, 397-411.

Janasoff, S. (1999). The songlines of risk. Environmental Values 8, 135-152.

Breakwell, G.M. (1994). The echo of power: a framework for social psychological research. The Psychologist 7, 65-72.

Douglas, M. (1992). Risk and Blame: essays in cultural theory. London: Routledge.

Becker, H.S. (1963). Outsiders: Studies in the Sociology of Deviance. New York: Free Press.

Bosk, C. (1979). Forgive and Remember. Chicago: University of Chicago Press.

Krogstad, U., Hofoss, D. & Hjortdahl, P. (2004). Doctor and Nurse Perceptions of Interprofessional Cooperation in Hospitals. International Journal of Quality in Health Care 16, 491-497.

Hunter, K. (1991). Doctor’s Stories. The narrative structure of medical Knowledge. Princeston, New Jersey: Princeston University Press.

Fox, N. (1992). The social meaning of surgery. Milton Keynes: Open University Press.

Freidson, E. (1970). Professional Dominance. New York: Atherton Press.

Soothill, K., Mackay, L. & Webb, C. (1995). Interprofessional Relations in Health Care. New York: Edward Arnold.

McDonald, R., Waring, J. and Harrison, S. (2006). Rules, safety and the narrativisation of identity: a hospital operating theatre case study. Sociology of Health and Illness 28, 178-202.

Read, J.G. and Bartowski, J.P. (2000), To veil or not to veil? A case study of Identity negotiation among Muslim women in Austin, Texas. Gender & Society 14, 395-417.

Casey, C. (1995). Work, self and Society: After Industrialism. New York: Rutledge.

Kohn, L.T., Corrigan, J.M. & Donaldson, M. S. (Eds) (1999). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.

Wilson, R.M., Runciman, W.B., Gibbard, R.W., Harrison, B.T., Newby, L. & Hamilton, J.D. (1999). The quality in Australian health care study. Medical Journal of Australia 163, 458-471.

Smith, A.F., Goodwin, D., Mort, M. & Pope, C. (2006). Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting British Journal of Anaesthesia 96, 715-721.

Slovic, P., Fischhoff, B. & Lichtenstein, S. (1979). Rating the risks. Environment 21, 14-20, 36-39.

Slovic, P., Fischhoff, B., Lichtenstein, S. (1979). Societal risk assessment: how safe is safe enough? In: Facts and Fears: Understanding Perceived Risk (eds. Schwing, J.E.R.C. & Albers, W.A.) pp. 137-144. New York: Plenum Press.

Morgan, K.M., DeKay, M.L., Fischbeck, P.S., Granger Morgan, M., Fischhoff, B. & Florig, H.K. (2001). A deliberate method for ranking risks (II): evaluation of validation and agreement among risk managers. Risk Analysis 21, 923-937.

Johnson, B.B. (2004). Risk comparisons, conflict and risk acceptability claims. Risk Analysis 24, 131-145.

Johnson, B.B. (2004). Varying risk comparison elements: effects on public reactions. Risk Analysis 24, 103-114.

Miles, S. & Rowe, G. (2004). The laddering technique. In: Doing Social Psychology Research (ed. Breakwell, G.M.), pp. 305-343. Oxford: Blackwell.

Russel, I.T. & Grimshaw, J. (1992). The effectiveness of referral guidelines: a review of the methods and findings of published evaluations. In: Hospital referrals (eds. Roland, M.O. & Coulter, A.) Oxford: Oxford University Press.

McDonald, R. & Harrison, S. (2004). The micropolitics of clinical guidelines: an empirical study. Policy & Politics 32, 223-229.

Gabbay, J. & Le May, A. (2004). Evidence based guidelines or collectively constructed ‘mindlines’? Ethnographic study of knowledge management in primary care. British Medical Journal 329, 1013-1017.

Reason, J. (2004). Beyond the organisational accident: the need for ‘error wisdom’ on the frontline. Quality and Safety in Health Care 13 (Supplement 2), ii28-ii33.

Cook, D.J., Montori, V.M., McMullin, J.P., Finfer, S.R. & Rocker, G.M. (2004). Improving patients’ safety locally: changing clinician behaviour. Lancet 363, 1224-1230.





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