Locating vulnerability in the field of patient safety

This thesis sheds new light on the problem of errors and adverse events in medicine. Itdoes so by considering patient safety from a critical, sociological perspective. Fourquestions drive the thesis: what is meant by patient safety and how did it develop intoa major focus for health services at the end of the 20th Century? How can patientsafety be examined from a social as well as technical perspective? What are thedifferences and similarities in the narratives about patient safety emerging fromclinicians, health services, patients and the media? What do these narratives tell usabout professionals' understanding of key concepts such as error, safety, risk andvulnerability? Empirically, I analyse via data mining techniques a sample ofexternally documented key international and national inquiries into adverse eventsand medical errors, and present the results of 30 focus groups comprising 195individuals who were asked about their views on patient safety.By applying an analytical framework drawn from the work of Bourdieu to these data,I show that what has generally come to be understood to be a technical endeavour,involving the identification of causes, and the implementation and evaluation ofsolutions to errors and adverse events, can be understood as a field within whichstakeholders struggle over taken for granted concepts of error, risk, safety andvulnerability. In doing so, stakeholders utilise a variety of strategies to gain thecultural, symbolic and social capital which can affect the quality of care available tovulnerable individuals and groups. By conceptualising patient safety as a field, it ispossible to expand our understanding of the causes of error into the social relationsand attitudes between patients and clinicians, and to capture how external forces, suchas the legal system, the media, and politics directly affect the practice of healthprofessionals