Surgical Patient Safety Officers in the United States: Negotiating Contradictions Between Compliance and Workplace Transformation

Abstract

A largely uncoordinated patient safety movement arose in response to the Institute of Medicine’s 1999 report on patient safety, To Err Is Human. Two key outcomes have resulted from that movement: (a) new guidelines that enlarge requirements for documenting compliance with patient safety data and (b) a new obligation for health care organizations to create a “safety culture” based on the “science” of safety. The organizational title patient safety officer (PSO) designates a member of an emerging occupation charged with assuming these enlarged responsibilities. This article seeks, first, to describe the emergence of this new organizational role, the PSO; second, to identify the new tensions that task and mission inflation have created for PSOs; and third, to examine how PSOs manage the tensions between their increased core work task and their new professional mission as agents of organizational change. Drawing on interviews conducted with 32 PSOs, 127 nurses, and 36 physicians in 17 surgical departments across 5 states in the United States from 2012 to 2015, the authors find that PSOs most commonly resolve the tension between core work activity and professional mission by focusing on their task as agents of audit and compliance. The authors find, as well, that when PSOs attempt to use their expanded role as social reformers to change behaviors in surgery, they must overcome the resistance of frontline workers. They require cooperation from executives and surgeons to effect change. When this support is unavailable, PSOs lose their voice and may abandon efforts to improve safety.