Identifying the underlying management strategies of developing patient safety - are they competing or complementary?

Management of a complex sociotechnical system requires making trade-offs or negotiating between several goals and means for attaining them. Research on organizing for quality implies that the improvement journeys of hospitals are laden with reliance on different management strategies to cope with challenges at various levels of the system (cf. Bate et al. 2008). Safety science has also identified several fundamental tradeoffs (such as the efficiency-thoroughness and optimality-fragility trade-offs) that have to be balanced when managing safety (Hollnagel, 2009; Woods & Branlat, 2011). General management research on the other hand has paid attention to competing values that exist in organisations and contrasting actions that managers need to engage in in order to manage the organisation effectively (Cameron & Quinn, 2011; Farjoun, 2010; Quinn et al., 2011). These approaches can provide important insight for managing patient safety. In the Finnish SafetyAsset research and development project, the goal has been to construct a model of patient safety management. Our findings during the project imply that there exist multiple strategies that more or less implicitly guide patient safety management activity. At least on a surface level these strategies also seem to be somewhat discordant. A need to better understand the underlying dialectics in patient safety management has emerged. We aim to clarify the nature of patient safety management by focusing on the underlying strategies governing it. Our research questions are: 1) What kinds of management strategies do managers and patient safety coordinators use in managing patient safety? 2) Are these strategies contradictory or complementary? 3) How should the different strategies be reconciled in patient safety management? Methods and materials:  We conducted 10 interviews with managers and patient safety coordinators between November 2011 and January 2012. The interviewees represented 4 different types of Finnish social and health care organisations. Interviews focused on the interviewees conceptualisations of their work and patient safety and their stories on how they had carried out patient safety management in their organisation. The results of the interviews were complemented with a reflective diary data from one patient safety coordinator in a Finnish hospital. Results:  In the presentation we present the identified strategies of patient safety management in the case organisations. Compatibility and reconciliation of the strategies will be discussed. Discussion and conclusions:  The possibility that the management strategies necessary for patient safety are at the same time both contradictory and complementary (cf. Farjoun 2010) will be discussed. The study will provide implications for practical patient safety management.