Narratives of professional regulation and patient safety: The case of medical devices in anaesthetics

Abstract

Government prescription for the management of clinical risk and patient safety relies upon the development of a shared perspective between stakeholders engaged in the delivery of healthcare about what constitutes clinical risk and what mechanisms are suitable to manage such risk to ensure patient safety. However, there are tensions arising from notions of clinical risk and its management, specifically between healthcare professionals and those managers given responsibility for implementation of policy. Central to these tensions are issues of legitimacy, power and identity in claims about how risk should be managed. Aligned with an emerging body of literature that takes a narrative approach to change in healthcare systems (e.g. Currie and Brown 2003), including patient safety (e.g. McDonald et al. 2005, 2006), our paper examines how healthcare professionals make sense of the regulation of single use medical devices (SUDs) in anaesthesia. Our study indicates that there is considerable resistance to detailed surveillance of SUDs. It appears that doctors author a narrative that privileges clinical judgement over managerial control in the use of SUDs, and this has come to be adopted by other healthcare professionals and managers. This may undermine future policy aspirations for the tighter regulation of clinical autonomy.

Keywords:

• narrative
• National Health Service
• legitimacy
• patient safety
• professional regulation
• single use devices

Notes

1. Note MHRA guidelines were revised and re-affirmed 2006 (MHRA 2006).

2. Due to the focus of this paper, only devices directly used by the anaesthetist are discussed.