Decision-making, uncertainty and risk: Exploring the complexity of work processes in NHS delivery suites

Abstract

The concept of the ‘risk society’ has focused on growing uncertainties about the benefits of scientific innovation and the reliability of professional judgement. Paradoxically, this has gone hand in hand with reductions in the actual risk associated with many activities and is often accompanied by demands for a technological fix. These contradictory impulses are especially evident in maternity care. While maternal and infant mortality rates have fallen, risk conscious patients are increasingly concerned about the possibility of professional mistake or malpractice. As a result, further categories of risk are created for organizations and professionals, particularly in relation to expensive litigation. Against this background, the paper reports on an ethnographic study of two delivery suites in which a computerized decision support system will be implemented. In the paper, we attempt to highlight some of the intricacies of work processes in delivery suites, specifically involving decision-making, risk, uncertainty, professional autonomy and medical knowledge. Our findings suggest a range of complexities that may considerably complicate the implementation of the computerized decision support system when it finally emerges and becomes embedded in delivery suites.

Keywords:

• Risk
• reproduction
• decision-making
• uncertainty
• health care

Acknowledgements

The research project, The technological management of childbirth—risk, empowerment and professional accountability, on which this paper is based, was funded by the ESRC Innovative Health Technologies Programme. We are grateful to Andrew Webster, the Director of this programme for his ongoing support of our work, the anonymous reviewers who suggested helpful revision in the rewriting of the first draft of this paper and all of the participants in this study. A special thanks to the editor of Health, Risk and Society, Andy Alaszewski, for his patience. It took us a little longer than usual to revise our paper, given that some of us moved jobs during the revision process.

Notes

1 Ventouse is a suction cup to extract the foetal head in labour. The vacuum extractor was invented by Malmstrom in 1954.

2 A slowing down of the heart rate below that which is regarded ‘normal’.