Enmeshing patient safety – intervening in the organization and practices of care

Health care, as situated practices of the everyday, unfolds in concrete settings, which are nevertheless influenced by ongoingorganizational agendas, and diverse in origin and timeframes. Patient safety practices are no exception – but how do practicesof local settings relate to the overall sense-making and articulation of work that takes place in the institution? What productivework can be discerned in the situated practices of patient safety and quality health care, i.e. also in the broader framing of theactivities, beyond the confines of the specific locality of action? The present paper examines the refiguring effects of patientsafety practices (Zuiderent-Jerak, et al. 2009; Pedersen 2017). From the relatively delimited contexts of their originalengagement, scrutiny is also given to ‘less visible’, perhaps ‘deleted’, organizational configurations in which patient safetypractices continue to perform. The paper draws on the notion of artful contamination (Zuiderent-Jerak and Jensen 2009),through which patient safety becomes enmeshed in the organizing of the institutional framework of a health care setting. Evenwhere patient safety does not figure as an explicit concern, it is thus seen to serve a role. The study points to the practicalsignificance of such translations in and for clinical practices.The objective of the study is to foreground the transformative potential of patient safety in organizing and reordering processesof healthcare work. With the healthcare practitioner in focus, the study points to the significance of their clinical work, yet alsointo matters of learning and interplay between professionals, work, and, more broadly, projects of the organization.The paper takes a retrospective approach, ex post case analyses of projects conducted in collaboration with a Maternal-ChildCare facility of a Danish hospital. The projects relate to neonatal milk kitchen and pediatric surgery ward practices. Sensitizingconcepts informed by Science and Technology Studies and generative design research are leveraged to explore and make senseof the relationships between the in situ and accomplished character of patient safety practices on the one hand, and acrosstheir immediate sites of action on the other (Nicolini 2012).Intervening capacities of safety practices in their further enmeshment points to the trade-offs or “artful contamination” throughwhich safety becomes a sustained, albeit less-pronounced, aspect of manifold processes in the agendas and work. Patientsafety initiatives manifest through other means, albeit not with the original problem-framing of patient safety and quality healthcare as being a key concern. It points to the unfolding of ‘patient safety’ practices and their partial connections in making theirrelevance in manifold ways. Such an irreductive vantage point in addressing and working with patient safety allows foropenness and flexibility to be leveraged, and in drawing on distribution of safety work in other practices.The study shows the relevance of patient safety practices as sustained beyond the scope and framing of the immediacy ofclinical practice. Through empirical synthesis, it shows how patient safety practices can be discerned as pertinent to diverseagendas of the organization.References• Nicolini, D. (2012). Practice Theory, Work, and Organization. Oxford: Oxford University Press.• Pedersen, K. Z. (2017). Organizing Patient Safety. London: Palgrave Macmillan.• Zuiderent-Jerak, T. & Jensen, B., C. (2009). Editorial introduction: Unpacking ‘intervention’ in Science and TechnologyStudies. Science as Culture 16(3): 227-235.• Zuiderent-Jerak, T., Strating, M., Nieboer, A. and Bal, R. (2009). Sociological refigurations of patient safety:Ontologies of improvement and ‘acting with’ quality collaboratives in health care. Social Science & Medicine 69(9):1713-21.