Accountability, organisational learning and risks to patient safety in England: Conflict or compromise?

Abstract

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Keywords:

• risk
• accountability
• organisational learning
• patient safety
• risk regulation

Notes

1. This research was undertaken before the announcement of the Coalition government, elected in May 2010, that it would abolish the NPSA and transfer the NRLS' functions to a new NHS Commissioning Board. Much of the debate concerning the abolition of the NPSA has highlighted continuing confusion between the two logics highlighted here, although it appears with the move of the NRLS to support commissioning that the ‘accountability’ logic may have gained in strength.