Abstract
Patient safety and quality of care are increasing concerns for healthcare internationally. This paper examines the spatial achievement of safety and wellbeing by healthcare staff, patients and their carers within UK primary care and Australian palliative care contexts. Two key socio-spatial modes of safety and wellbeing were found across these healthcare contexts. The technical mode was spatially managed by staff and driven by formal approaches to safety with a limited focus on wellbeing. In contrast, the relational mode was driven by attentiveness to the wellbeing and spatial engagement of staff, patients and carers that drew on informal elements of safety. Both modes extended across public, private, biomedical and administrative spaces, with technical and relational safety-wellbeing configurations often inhabiting the same spaces. Differences also existed across primary and palliative care contexts that reflected the unique pressures present within each context, and the ability of people and places to adapt to these demands. In the context of increasing workloads in healthcare internationally, this study highlights the benefits of attending as much to the relational dimensions of safety and quality of care as to the technical ones through increased focus on the safety and wellbeing of healthcare staff, patients and carers within and beyond traditional sites of care.
Highlights
Over the past decade, there has been a trend in the social sciences towards what has been termed a ‘spatial turn’ (Warf and Arias, 2008)
This paper examines the spatial achievement of safety and wellbeing by healthcare staff, patients and their carers within UK primary care and Australian palliative care contexts
This paper examines the spatial achievement of safety and wellbeing by healthcare staff, patients and carers across two healthcare contexts: UK primary care and Australian palliative care
Summary
There has been a trend in the social sciences towards what has been termed a ‘spatial turn’ (Warf and Arias, 2008). More recent approaches to understanding healthcare spaces have emphasised their informal qualities and how they incorporate different modes of socio-spatial ordering (e.g. biomedical, emotional) (Lefebvre, 1991; Street and Coleman, 2012) These have been shown to continually realign to create dynamic socio-spatial configurations between human actors and their wider spatial environments (Law and Mol, 2001; White et al, 2012). Dominant approaches to patient safety improvement have historically involved the application of ‘measure-and-manage’ approaches (e.g. Significant Event Analysis) to formally identify features of a workplace or clinical process where performance can be improved through strict adherence to formal guidelines (Reason, 1990; The Health Foundation, 2011) While these approaches have led to significant improvements, the complex interrelationship between people and their wider workplace environments mean that cause and effect are not always linked in a predictable manner (Iedema et al, 2006; Patterson, 2008). Rather than focus on the elimination of error, this research focuses on how risk is mitigated and safety achieved through informal knowledge and collaboration between professionals, patients and carers (Braithwaite et al, 2015; Waring et al, 2015)
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