Abstract
This article examines the challenges in regulating patient safety during hospital discharges in England through the lens of liminality. Hospital discharges are internationally recognised as being a dangerous time for patients, and yet the role that regulators should play in addressing this has received little attention in any jurisdiction. Liminality’s spotlight on the in-between highlights how the discharge process can give rise to patient safety incidents that fall between regulator’s boundaries. Falling between boundaries results in a dearth of effective regulatory responses to address these incidents. By positioning the new role of Patient Safety Commissioner (PSC) as that of a ‘Representative of Order’, this article proposes a means by which this poorly regulated space could be navigated more successfully. This analysis suggests that the remit of the PSC role be expanded to include improving patient safety with regard to processes – not just medicines and medical devices. The full implications of this are also addressed.
Highlights
Understanding patient safety and hospital dischargesWe have found that the healthcare system – in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers – is disjointed, siloed, unresponsive and defensive
This article has used the anthropological concept of liminality as a lens through which to explore and identify regulatory challenges in addressing patient safety issues related to hospital discharges
This has brought into focus the liminal space that exists among regulatory bodies within the hospital discharge regulatory arena
Summary
We have found that the healthcare system – in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers – is disjointed, siloed, unresponsive and defensive. The third section introduces the concept of liminality, and illustrates the liminal space within this context It shows how this space occurs as a result of the plethora of regulators and the related challenge of forming a unified understanding and prioritisation of the risk posed by hospital discharges.[11] Actions taken to improve safety during discharges (typically the production of a report) often fail to have the desired impact. To minimise this undesirable occurrence, this article envisages that the new PSC role could function as a Representative of Order. The fifth section incorporates learning from this example to illustrate how the PSC, when cast as a Representative of Order, could help regulators overcome the difficulties identified in the third section
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