Anneliese Dodds

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting

OBJECTIVE Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. DESIGN Qualitative research design using documentary analysis and semi-structured interviews. SETTING Two large teaching hospitals in London; one providing acute and the other mental healthcare. PARTICIPANTS Sixty-two healthcare practitioners with experience of reporting and analysing incidents. RESULTS Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. CONCLUSION Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

How does globalisation interact with higher education? The continuing lack of consensus

This essay attempts to ascertain whether a particular meaning of globalisation, and view on its effects and the appropriate response to it, are becoming standardised across academia. To do so, it content‐analyses a representative sample of new scholarship, mapping the various approaches of current researchers towards globalisation. The essay shows how globalisation remains a contested concept within studies of higher education, as in many other fields. Rather than globalisation being taken to refer unambiguously to global flows, pressures or trends, its meaning continues to depend on the particular perspective adopted by contemporary researchers. The same conflict is apparent concerning the impacts which are reputed to globalisation and with regard to the appropriate response to globalisation amongst academics and higher education institutions (HEIs) more generally. Perhaps the only apparent point of consensus amongst contemporary researchers is the claim that globalisation affects HEIs, rather than HEIs themselves being implicated in the promotion of globalisation. This position underplays the often important role of HEIs in encouraging cross‐border flows and pressures, and global trends such as marketisation.

Accountability, organisational learning and risks to patient safety in England: Conflict or compromise?

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Understanding institutional conversion: the case of the National Reporting and Learning System

This article focuses on one type of institutional change: conversion. One innovative approach to institutional change, the “political-coalitional approach”, acknowledges that: institutions can have unintended effects, which may privilege certain groups over others; institutions are often created and sustained through compromise with external actors; and institutions’ external context can vary significantly over time, as different coalitions’ power waxes and wanes. This approach helps explain the conversion of one institution drawn from the UK National Health Service, the National Reporting and Learning System. However, the shift of this system from producing formative information to facilitate learning to promote safer care, towards producing summative information to support resource allocation decisions, cannot be explained merely by examining the actions of external power coalitions. An internal focus, which considers factors that are normally viewed as “organisational” (such as leadership and internal stability), is also required.

The British higher education funding debate: the perils of 'talking economics'

This article examines current debates surrounding British higher education funding from a political economy perspective, drawing on ‘positive’ and ‘institutionalist’ political economy. Adopting the lens of political economy enables a critical assessment of the use of terms drawn from economics by many higher education decision-makers. Current discussions embody particular assumptions about the nature of producers and consumers in higher education, the relationship between supply and demand, and the role of information in the higher education ‘market’. They also frequently fail to acknowledge the active rather than passive role of higher education institutions in shaping policy discussions surrounding higher education funding.

Public administration in an age of austerity:the future of the discipline

Reflecting changes in the nature of governance, some have questioned whether Public Administration is now an historical anachronism. While a legitimate debate exists between sceptics and optimists, this special issue demonstrates grounds for optimism by indicating the continuing diversity and adaptability of the field of Public Administration. In this introduction, we first sketch the variety of intellectual traditions which comprise the field of modern Public Administration. We then consider institutional challenges facing the subject given considerable pressures towards disciplinary fragmentation, and ideological challenges arising from a new distrust of public provision in the UK. Despite these challenges, Public Administration continues to provide a framework to analyse the practice of government and governance, governing institutions and traditions, and their wider sociological context. It can also directly inform policy reform – even if this endeavour can have its own pitfalls and pratfalls for the ‘engaged’ academic. We further suggest that, rather than lacking theoretical rigour, new approaches are developing that recognise the structural and political nature of the determinants of public administration. Finally, we highlight the richness of modern comparative work in Public Administration. Researchers can usefully look beyond the Atlantic relationship for theoretical enhancement and also consider more seriously the recursive and complex nature of international pressures on public administration.

Environmental governance in a contested state:the influence of European Union and other external actors on energy sector regulation in Kosovo

This article examines environmental governance in Kosovo, with a particular focus on the energy sector. The article considers the degree to which the emerging model of environmental governance is characterised by hierarchical and non-hierarchical modes of coordination. We examine the roles of a number of domestic institutions and actors – ministries, agencies, and regulatory bodies– and the influence of external actors, including the European Union, the United States, and Serbia. The European Union is building Kosovo’s own hierarchical governance capacity by strengthening domestic institutions, whilst the United States focuses primarily on market liberalisation, whilst simultaneously supporting European Union efforts. Moreover, environmental policy change is not wholly or predominantly driven by domestic actors, which can partly be attributed to Kosovo’s limited domestic sovereignty. We conclude that the emerging model of environmental governance in Kosovo is characterised by a weak hierarchy, partly as a result of external actor involvement, which disincentivises the government from responding to domestic non-state actor pressure.

Logics, thresholds, strategic power, and the promotion of liberalisation by governments: a case study from British higher education

Liberalisation has become an increasingly important policy trend, both in the private and public sectors of advanced industrial economies. This article eschews deterministic accounts of liberalisation by considering why government attempts to institute competition may be successful in some cases and not others. It considers the relative strength of explanations focusing on the institutional context, and on the volume and power of sectoral actors supporting liberalisation. These approaches are applied to two attempts to liberalise, one successful and one unsuccessful, within one sector in one nation – higher education in Britain. Each explanation is seen to have some explanatory power, but none is sufficient to explain why competition was generalised in the one case and not the other. The article counsels the need for scholars of liberalisation to be open to multiple explanations which may require the marshalling of multiple sources and types of evidence.