The social process of escalation: a promising focus for crisis management research.

Johan Bergström,James M Nyce,Sidney Dekker,Isis Amer-Wåhlin

doi:10.1186/1472-6963-12-161

Johan Bergström, James M Nyce + Show 2 more

Open Access

https://doi.org/10.1186/1472-6963-12-161

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Abstract

BackgroundThis study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis.DiscussionBased on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency.ImplicationsThe concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

Highlights

This study identifies a promising, new focus for the crisis management research in the health care domain
Reviewing the research of health care crisis management, there seems to be a knowledge-gap concerning the process of organisational change and adaption, especially as a situation goes from normal, to non-normal and further into a state of crisis
Instead of viewing escalation as a process uncoupled from its social context, the present analysis suggests that it is necessary to outline a theory for escalation as a social process in which coordination and cognitive activity are highly interrelated

Summary

Discussion

Consistent with the principle of epistemological pluralism [34] this discussion will explore, using multiple theoretical perspectives, the problem of obstetrical interventions. Accepting patients “too” early in the natural process of labour can well medicalise problems a delivery unit cannot handle typically well This can lead to a situation where a normal birth is defined as a nonnormal labour (a definition that influences the social construction of escalating obstetrical situations) and the response is to medically induce labour. Almost all midwifes are well aware that they may often be calling someone with less experience and competence than themselves to handle crises or emergencies because in most deliveries one turns first a junior physician [19] What these calls for an obstetrician do is in effect to mark an organisational transition, i.e., a shift from a normal situation to a crisis.

Background

36. Feld MD: Information and authority

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