Certain uncertainties: Modes of patient safety in healthcare

Abstract

The safety movement in healthcare approaches patient safety mainly by reducing uncertainty to prevent possible errors. This article is concerned with how this approach relates to other modes of conceptualising patient safety. Following the work of Georges Canguilhem, I argue that, depending on how we conceptualise knowing, acting and error, a different mode of patient safety is possible: one that involves ‘living with uncertainty’. Through ethnographic research on daily clinical work in Dutch primary care facilities, I show that the assumption that clinical work can be made safe by reducing errors not only is problematic, it also creates new forms of ‘unsafety’. My observations at general practitioners’ out-of-hours service units and other primary care facilities display a ‘continuous stream of knowing and acting’ in which care professionals adopt specific practices that avoid contradictions between uncertainty and safety. Although these practices differed in the various locations I studied, there were some common dimensions of ‘living with uncertainty’. By problematising the conceptions of safety and errors as antonyms I suggest that a reappraisal is in order, particularly of the notion of errors in healthcare. Keeping and protecting room for errors in a situated way is crucial for knowing and acting in a field riddled with uncertainty and dealing with human life.