title: Multiple accountabilities in incident reporting and management.
abstract: In this article, we examine the current and increasing emphasis on accountability and patient safety in health care, focusing on practices of incident reporting and management in New South Wales, Australia. We describe the frames of accountability associated with an incident reporting system, and explore how this system manifests in practice. In contrast to literature that situates incident reporting and local practices as oppositional, we used ethnographic methods to observe the incident management practices of clinical staff in a hospital, and found evidence to characterize this relationship differently. We found that accountability has multiple conceptualizations, and we present three findings that demonstrate how the reporting system and incident management policy are interwoven with local enactments of accountability. We suggest that systematic efforts toward improvement cannot be divorced from the local context, and emphasize the importance of local ecologies of practice in facilitating the meaningful utilization of such incident reporting systems.
authors.affiliation: University of Technology, Sydney, New South Wales, Australia. suyin.hor@student.uts.edu.au
authors.forename: Su-yin
authors.initials: SY
authors.lastname: Hor
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.forename: Katrina
authors.initials: K
authors.lastname: Williams
authors.forename: Les
authors.initials: L
authors.lastname: White
authors.forename: Peter
authors.initials: P
authors.lastname: Kennedy
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Day
mesh_terms: D000884:Anthropology, Cultural / Q000379:methods; D003142:Communication; D003469:Culture; D006291:Health Policy; D006801:Humans; D033183:Interdisciplinary Communication; D009517:New South Wales; D005791:Patient Care / Q000379:methods* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration*; D012308:Risk Management / Q000379:methods* / Q000458:organization & administration; D012449:Safety / Q000592:standards*; D012941:Social Responsibility