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Exploring structure, agency and performance variability in everyday safety: An ethnographic study of practices around infusion devices using distributed cognition

Furniss, D; Mayer, A; Franklin, BD; Blandford, A; (2019) Exploring structure, agency and performance variability in everyday safety: An ethnographic study of practices around infusion devices using distributed cognition. Safety Science , 118 pp. 687-701. 10.1016/j.ssci.2019.06.006. Green open access

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Abstract

Infusion safety is a recognised concern internationally. While few observational studies explore the causes of the errors that occur, even fewer describe how safety is maintained in routine practice. We sought to understand safety around infusion devices. Methods: An ethnographic study of infusion device use was conducted on a haematology ward. This included observations of 51 infusions, plus their preparation where possible, during 120 h of ward observation over 11 days. Field notes were transcribed and analysed using deductive coding informed by distributed cognition. A further inductive thematic analysis highlighted new themes for making sense of the data. Results: The distributed cognition analysis highlighted how infusion treatment was affected by interactions distributed across artefacts, tasks, social networks, physical space and time. These interactions occurred close to and away from the infusion: at micro, meso and macro levels according to distance from the actual process. The inductive analysis highlighted three new interdependent themes that account for how safety is constructed and compromised: structure, agency and performance variability. Discussion and conclusion: Safety is constructed through the co-evolution of sociotechnical structure and agency whereby structure shapes and influences people's behaviour and people reproduce and create structures. Everyday performance variability emerges from these interactions, including deviations in processes and outcomes (e.g. incidents, near misses and opportunities). Studies of everyday safety can explore interactions between four points of a sociotechnical structuration model: structure, agency, and satisfactory and unsatisfactory performance.

Type: Article
Title: Exploring structure, agency and performance variability in everyday safety: An ethnographic study of practices around infusion devices using distributed cognition
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ssci.2019.06.006
Publisher version: https://doi.org/10.1016/j.ssci.2019.06.006
Language: English
Additional information: © 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).
Keywords: Agency, Distributed cognition, Infusions, Safety II, Structuration theory, Structure
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Computer Science
URI: https://discovery.ucl.ac.uk/id/eprint/10076645
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