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LEARNING SAFE MEDICAL PRACTICES : THE UNSOCIABLE FABRIC OF AN ORGANISATION ?

This paper concerns social participation within and across organisational units, and the role of contextual conditions in learning safe medical practices within specialised health care services. The research design is a case study approach within a regional Norwegian hospital. The paper describes positive safety practices within organisational units related to openness and communication, teamwork, non-punitive attitudes, and supervisor/manager expectations and actions. Despite these positive tendencies, issues of underreporting, collegial mechanisms and differences in safety perception and work norms among physicians and nurses are also present. Safety practices across organisational units create unfavourable conditions for learning in the case hospital, based on problems with handoffs and transitions, and lack of collaboration between units and divisions. Taken together with results on contextual conditions such as staffing, work pressure, environmental uncertainty in forms of economic pressure, and challenges related to collaborative climate (physician/nurse) and top management support, the picture becomes a complex web of related issues that contribute to the creation of what in this paper has been called an unsociable fabric for learning. 1 Correspondence to: Karina Aase, University of Stavanger, Faculty of Social Sciences, N-4036 Stavanger, Norway. Telephone: +47-51831534, Fax: +47-51831550, Email: karina.aase@uis.no