Patient Safety Culture and Health Care Ethics

Summary 1 

The article Staff silence about abuse in health care by Brüggemann and Swahnberg elucidates on the subject of the silence of medical officers in the face of abuse in Swedish hospitals. The article reports on an actual research undertaken by healthcare professionals in a gynecology hospital in Sweden. The subject of the research is related to the important subject of patient abuse in healthcare institutions as well as why professionals are quiet about the same. The first hypothesis of going into the research itself was that auxiliary hospital, being closest to the patients were most likely to be aware and communicate about patient abuse (Brüggemann & Swahnberg, 2014) . The second hypothesis was that staff members who themselves had suffered abuse as patients were more likely to report of patient abuse in the hospital (“wounded healers”). After reporting on the research itself, the article also includes an in-depth discussion that seeks to synthesise the results. Based on the totality of the article, abuse is rife in Swedish hospitals and most staff members involved will not speak about it for personal and professional reasons save for senior staff and “wounded healers”. 

The hypothesis upon which the actual research is carried out is based on an intensive literature review that is included in the introductory part of the article. The literature review reveals that abuse has been going on in Swedish hospitals and includes “ physical, sexual, and health care abuse ” ( Brüggemann & Swahnberg, 2014, pp.71 ). The focus of the research, however, was on why such abuse can be ongoing yet no health care officials, who must be aware of it do not report. This led to a research on all professional members of staff at a Swedish women’s clinic, carried out by the Nordic research network (NorVold) using the NorVold Abuse Questionnaire (Brüggemann & Swahnberg, 2014) . The questionnaire was specifically designed to factor all four types of abuse indicated hereinabove. 

The results from the actual research showed that abuse was indeed prevalent at the clinic with several staff members having heard about it within the previous twelve months. However, a trend was noted where contrary to expectation, most auxiliary members of staff reported not to have heard of any abuse. It was, however, the senior staff including gynecologists and midwives who reported on being aware of abuse at the institutions (Brüggemann & Swahnberg, 2014) . Finally, the highest propensity for having heard about patient abuse was among the “wounded healers”. 

The discussion part of the article analyses the results and seeks to understand their meaning more so with regard to the reversal of hypothesis about the auxiliary staff. This is because it is auxiliary staff who ought to be more aware of abuse since they are the ones most closely interacting with the patients (Brüggemann & Swahnberg, 2014) . Among the explanations given by the researchers is that perhaps the auxiliary members of staff are well aware of such a high level of patient abuse on the Swedish healthcare system that whatever abuse that had happened at the women’s clinic seemed normal. The senior staff, being more knowledgeable and experienced could, however, tell the difference between normal abuse and treatment more clearly. Another explanation would be the existence of a code of silence amongst auxiliary staff. This would explain why the “wounded healers” were more outspoken than the rest of the auxiliary team since their empathy to the patient is higher than their commitment to the code of silence (Brüggemann & Swahnberg, 2014) . Having a better understanding of the cause of silence through further research was indicated as an important step in curbing the problem of patient abuse. 

Summary 2 

The article titled Culture, silence, and voice: The implications for patient safety in the operating theater by Jones and Durbridge ventures into the subject of human error in the handling of patients, why professionals who notice it would be quiet about it, and the solution thereto. The article is based on the fact that just like in other professions, human input plays a very important role. However, whenever there is a human inference, there is also a propensity for error. In the case of healthcare professionals, human error can lead to great suffering and even death of a patient (Jones & Durbridge, 2016). However, in scenarios where expert human inference is generally employed such as during surgical operations, the professionals are never alone. Therefore, another professional will be able to notice when a human error happens. However, many professionals will not report when they notice a human error making many errors go unnoticed and unremedied, while also denying the professional who made the error a learning opportunity. 

The safety of patients within a healthcare institution is inter alia determined by the safety culture of that organization, according to the instant article. As part of an organizational culture, organizations gradually develop an active and passive approach towards the subject of safety. Some organizations will establish rigid and rigorous safety rules that seek to ensure that the safety of their patients is paramount. Yet others will consider safety as secondary to other subjects such as efficacy and protecting the reputation of the organization itself (Jones & Durbridge, 2016). The safety culture will, therefore, inform whether or not a member of staff will report on the human error of another during a joint medical procedure. 

From a psychological perspective, personal preservation is an integral and almost primal human inclination. When a medical team works together and are considered as one entity, an error of a singular member may be construed as a manifest weakness within the entire team. Therefore, a professional who notices an error that could have dire ramifications for a member of the team may be reluctant to share it under the concept of personal preservation (Jones & Durbridge, 2016). It would feel like sharing the weakness of a team member will also adversely affect the entire team. This has contributed to a culture of silence when human error is noticed within a closely knit medical team. 

Another common reason why human error is not reported during joint procedures is because there is a higher susceptibility for error for senior staff than junior staff. Father, the errors committed by junior staff are of lesser impact and easily correctible than those conducted by senior members of staff. This results in a scenario where it is the junior members who are tasked with the obligation of having to report senior members of staff when they commit an error. The issue of juniors fearing to report their seniors crosses professional barriers and has been seen in different professions (Jones & Durbridge, 2016). It has also been blamed for many errors. 

The solution to this predicament is placing safety over and above all other considerations as part of the safety culture of any institution. Therefore, safety will be more important than the reputation of a team thus eliminating the psychological inclination for self-preservation through condoning errors. Secondly, safety will take precedence over any other considerations within the institutional culture such as efficacy and resource management (Jones & Durbridge, 2016). Most importantly, the juniors will be empowered to speak out to their seniors and point out their mistakes before it is too late. When safety takes up precedence over any other consideration in a hospital, it will tune the instincts of every member of teams working on a patient to be on the lookout for any errors and speak out when it happens. Another important aspect of the safety-first culture is to avoid victimization of juniors who speak up or rush action against the seniors whose errors have been called out (Jones & Durbridge, 2016). These will create a unified voice for safety and against errors, leading to a safer environment for patients. 

References 

Brüggemann, A. J., & Swahnberg, K. (2014). Staff silence about abuse in health care: An exploratory study at a Swedish women’s clinic.  Clinical Ethics ,  9 (2-3), 71-76 

Jones, C., & Durbridge, M. (2016). Culture, silence, and voice: The implications for patient safety in the operating theater .  Journal of Perioperative Practice ,  26 (12), 281-284