Academic journal article Health Sociology Review

Challenges in Achieving Positive Outcomes for Children with Complex Congenital Conditions: Safety and Continuity of Care

Academic journal article Health Sociology Review

Challenges in Achieving Positive Outcomes for Children with Complex Congenital Conditions: Safety and Continuity of Care

Article excerpt


In this article we illustrate the issues which impact on providing good outcomes for the baby, the mother, the doctors and hospital staff according to the standards of patient safety and family-centred care protocols of the public paediatric tertiary hospital in which the study was conducted. Both positive and negative issues will be explored in outlining the negotiations which shaped the way health care unfolded for one particular baby.

The article begins with the journey of a newborn infant with a complex congenital anomaly through the state health system. The journey outlined indicates the existence of a rural-urban divide and alerts us to the complexities of the health care system that straddle both. These complexities often require clinicians to step outside the normal boundaries of their job descriptions in order to provide the best quality of care and safety for their patients. For example, clinicians in public tertiary hospitals which are mandated by the state to accept emergency patients from rural and regional areas require particular knowledge of the transport and triage systems that incorporate and execute these services.

The challenges inherent in providing quality of care in a climate of sophisticated technologies, complex diseases and increasingly complex hospital systems rely on the resourcefulness and adaptability of clinicians to ensure the safety of the patients and optimal quality of care for them. Several authors refer to this adaptability as resilience, 'the ability to adapt or absorb disturbance, disruption, and change...' (Patterson et al 2007). The base concept is that failures are breakdowns in normal adaptive processes. Others perceive resilience as hidden competencies; the informal measures which are unplanned but built into the systems structures compared to the intended formal measures that are put in place to ensure proper care and safety of patients (Mesman 2007). Systems are not fail-safe; whenever gaps or discontinuities of care occur hospital systems' personnel, medical administrators and the public compel clinicians to develop failure-sensitive strategies to forestall negative outcomes. In the case of this newborn the challenges to patient safety and quality of care were overcome and negative outcomes did not eventuate.

Doctors regard 'system' errors or failures in two ways (Waring 2007). First, they are regarded as the impersonal, structural and organisational forces which frame care provision, such as staff shortages, resource limitations or seasonal pressures, the transport systems and networks for transferring patients between hospitals, between rural-urban locations and the state bed management system. Clinicians develop unique capabilities for dealing with distance and dispersed services and they utilise their professional networks in informal and resourceful ways to expedite procedures.

The second way doctors think about errors focuses on the activities of individuals or groups who are perceived to undermine the expected level of clinical care (Waring 2007). These can be linked to the professional qualities of individual clinicians in practice that are learnt in medical training (Koster et al 2007). These attributes are personal characteristics and in the medical profession are referred to as 'professional dispositions' (Sinclair 2000:260). They include qualities such as responsibility, knowledge and experience. If we consider clinicians' routine boundaries of work, and when those boundaries are challenged by a rural-urban divide as mentioned in the introduction, these kinds of dispositions manifest themselves in extended form as requirements for clinicians. The strength of personal quality development in individual clinicians is related to the resources of resilience which can be drawn upon when there is pressure on resources and performance.

Clinicians' everyday work practices can be described as material labour, i.e. all dimensions of physical and mental labour which is generated by the individual body of the clinician in treating a hospital patient. …

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