The emerging discourse of patient safety – the research and publication contribution of Frank Milligan

Abstract

Introduction - This thesis presents the portfolio of evidence required for the award of a PhD by publication at the University of Bedfordshire. The theme that runs throughout is the contribution of the work analysed to the discourse of patient safety in terms of the theoretical, educational, practice development and research contribution made by the author. Aim and objectives - The aim of the portfolio is to provide a critical analysis of the contribution made by the author to the growing discourse of patient safety. The objectives were to synthesise those contributions through a narrative analysis of the publications with particular reference to: 1. The delineation of patient safety as a viable discourse in healthcare 2. The changing role of medicine as a profession within the context of patient safety 3. The centrality of human factors theory in improving future patient safety practice 4. Safety culture, its definition and problematic relationship with safeguarding 5. Education and healthcare practice. The literature - The publications included here range in time scale from 1998 to 2017. Twenty-four pieces of literature are analysed and consist of a co-edited book, three research reports, four chapters from two different books and sixteen peer-reviewed journal articles. A citation summary for these publications is provided in Appendix 1. Key themes - Early publications focused on a critique of western medicine in order to highlight the unnecessary harm that was occurring in medically dominated healthcare systems. This critique moved through the concepts of iatrogenesis and adverse events before settling on patient safety as the key concept through which to influence quality enhancement in healthcare practice. The range and scale of the authors publications reviewed here added value to concepts such as safety culture and the centrality of patient safety incident reporting in such cultural shifts. Other aspects of human factors theory were promoted, most notably the Human Factors Analysis and Classification System leading on to research in the field of medication safety, human factors and safety culture in the context of the nursing home setting. These and other recent publications have highlighted inconsistencies in the relationship between patient safety and safeguarding, and argue that safeguarding has led to something of a return to the blame culture that has been historically present in healthcare. Conclusion - Patient safety is now a priority in healthcare, although one that has to operate within the political and financial constraints that are inevitably associated with healthcare provision. The evidence and analysis given here shows that the publication and research record generated has both reflected and facilitated the growing discourse of patient safety.