Trenholme Junghans, M.Phil.

Theories of the “Risk Society”Ulrich Beck and Anthony Giddens

Beck:1992: Risk Society: Towards a New Modernity1999: World Risk Society

Giddens:1990: The Consequences of Modernity1991: Modernity and Self-Identity: Self and

Society in the Late Modern Age

“Risk Society” cont’d.the current moment is characterized by a

preoccupation with risk avoidance

risk is seen to increasingly derive from man-made systems rather than nature

scientific and technological expertise are seen less as potential risk ameliorators than as sources of uncertainty and insecurity

“Risk Society” cont’d.shift of emphasis from “invisible to visible to

virtual risks and the change in the spatial, temporal, and demographic distribution of risk giving rise to borderless risks” (Ekberg 2007: 344)

E.g., threats of nuclear contamination, biological agents, and genetically modified life forms

The probability of exposure to such risks might be low, but the potential consequences of exposure are correspondingly high -- statistically rendered

“Risk Society” cont’d.the proliferation of risk definitions

compromises effective risk communication

trust (particularly trust in the content of science and the conduct and governance of scientists) declines as risk is perceived to increase

the resulting ethos is one of reflexivity

Audit Culture and Risk ManagementMichael Power

1999 The Audit Society: rituals of verification2005 Organizational Encounters with Risk (ed.

with Hutter)2007 Organized uncertainty: designing a world

of risk management

Marilyn Strathern2000 Audit Cultures: Anthropological Studies

in Accountability, Ethics and the Academy

Patient Safety as Risk Management/Risk Governance?a shift from an emphasis on the content of risk

knowledge to the process of risk management Inhibits the sort of “disruptive intelligence” which

potentially enhances organizational performancethe triumph of a “false precision” whereby

techniques of audit and measurement feed into an illusion of scientificity

by means of a pervasive atmosphere of organizational defensiveness which “defines the responsible organization as one that leaves ‘no fear unturned’”

“Safety” as an especially slippery epistemological object: “Because danger is often unobservable, it is

impossible to determine for certain when we are safe. As the absence of danger, safety is the absence of something that is often unobservable in the first place. While it is sometimes possible to tell when danger is present, it is impossible to tell for certain that it is completely absent. Since there are numerous ways for any item or situation to be dangerous, designating something as safe requires ignoring all possible ways it might be dangerous.” (Simpson, 1996)

Proposition 1

Proposition 1: risk and safety are intrinsically unmeasurable; they can only be represented by proxy, and in the negative. At the same time, practices of risk management, audit and accountability create pressures to “fix” the unmeasurable, and hence have a tendency to mistake the measurement (proxy or sign) for the “reality” and in the process to close spaces of uncertainty and ambiguity.

Proposition 2

Proposition 2: To work well, members of any team need “psychological safety” (Edmondson 1999; Fraher and others). This circumstance gains particular resonance in the case of professionals working in “risky” businesses, often referred to as High Reliability Organisations (Fraher; Weick), of which medicine is certainly one.

Hypothesis Many of the efforts made to stabilize,

translate and measure the inherently elusive phenomena and practices associated with patient “safety” operate at the expense of the preconditions of psychological safety required for effective teamwork in general, and the arguably heightened safety requirements of individuals and teams engaged in the “risky” work of health care provision in particular.

Second body of Literature:

The psychodynamic literatureTavistock Institute and the study of group

relations(Wilfred Bion, Isobel Menzies, Larry Hirschhorn,

Anton Obholzer, Davide Nicolini, Yiannis Gabriel, Amy Armstrong, Amy Fraher)Bion, 1961 Experience in GroupsHuffington et. al. 2004 Working Beneath the Surface:

the emotional life of contemporary organizationsThe Object Relations Tradition (Melanie Klein,

D.W. Winnicott)Winnicott, 1971 Playing and Reality

The psychodynamic literature, cont’d. Bion:

The distinction between “defense” and “task”Regarding patient safety, what happens when

a defense (safety) becomes the primary task?

Winnicott:Transitional objects, experiences, and spacesRegarding patient safety, what happens when

these vital spaces are closed?