Narratives of professional regulation and patient safety: The case of medical devices in anaesthetics

Government prescription for the management of clinical risk and patient safety relies upon the development of a shared perspective between stakeholders engaged in the delivery of healthcare about what constitutes clinical risk and what mechanisms are suitable to manage such risk to ensure patient safety. However, there are tensions arising from notions of clinical risk and its management, specifically between healthcare professionals and those managers given responsibility for implementation of policy. Central to these tensions are issues of legitimacy, power and identity in claims about how risk should be managed. Aligned with an emerging body of literature that takes a narrative approach to change in healthcare systems (e.g. Currie and Brown 2003 Currie, G. and Brown, A. D. 2003. A narratological approach to understanding processes of organizing in a UK hospital. Human Relations, 56(5): 563–586. [Crossref], [Web of Science ®] , [Google Scholar]), including patient safety (e.g. McDonald et al. 2005 McDonald, R., Waring, J. and Harrison, S. 2005. ‘Balancing risk, that is my life’: the politics of risk in a hospital operating theatre department. Health, Risk & Society, 7(4): 397–411. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar], 2006 McDonald, R., Waring, J. and Harrison, S. 2006. Rules, safety and the narrativisation of identity: a hospital operating theatre case study. Sociology of Health and Illness, 28(2): 178–202. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), our paper examines how healthcare professionals make sense of the regulation of single use medical devices (SUDs) in anaesthesia. Our study indicates that there is considerable resistance to detailed surveillance of SUDs. It appears that doctors author a narrative that privileges clinical judgement over managerial control in the use of SUDs, and this has come to be adopted by other healthcare professionals and managers. This may undermine future policy aspirations for the tighter regulation of clinical autonomy.