Short abstract:

This academic paper explores how a focus on the everyday practices of ‘doing safety’ offers a potential interpretive aid for understanding moments of translation and adaption in how local safety cultures are accomplished.

Long abstract:

After two decades of systems thinking in healthcare, it is difficult to demonstrate increased safety. The systems approach has been criticized for its functionalist ontology (Caldwell 2012) which privileges a technical, de-coupled and systemic understanding of reality, rather than situation-based, everyday accomplishments (Bertels et al. 2016; Waring 2015). ‘Safety culture’ is difficult to operationalise as it is ‘slippery’ (defies classification) and ‘sticky’ (socially embedded) (Waring, 2015). In response to calls for ‘endeavours that prioritise practical change and local involvement over knowledge production’ (Jorm et al. 2021), this paper describes how we developed an interpretive aid, designed to be used collaboratively, in context, by care teams to explore and enrich their own safety culture.

We present empirical data from an interview study of maternity/neonatal leaders /safety managers in England which informed the development of the interpretive aid. Our initial focus of enquiry centred on the local accomplishment of cultural values through collaborative routines or situated practices (Mesman 2007) and the ways in which actors/teams actively tailored practices according to their local environments.

We explore how ordinary, taken-for-granted practices as a category of analysis (i.e., safety huddles, staff allocation) can provide a potential ‘window’ to explicate ambivalences, contradictions, accommodations and transformative possibilities (Neal and Murji 2015; Feldman 2022). We share insights (and tensions) from our ongoing collaborative work (with clinical staff and policy makers) to fold abstract grand notions of safety culture into the ‘small’ everyday moments and to situate these reflective processes within a wider programme of leadership and culture change