Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: As the movement for patient safety has exploded across the US health care industry, an appeal for the creation and extension of ‘cultures of safety’ has been a rallying cry of reformers. For guidance in developing safety culture, patient safety advocates have looked to other industries for assistance, in hopes of efficiently transferring safety expertise into health care. Cited for its high reliability and successful safety record, the aviation industry has been an influential model for the development of patient safety. This attempted transfer of expertise organizes a series of guiding questions for the proposed presentation. What do safety experts mean by a culture of safety? How does aviation become a model for such a culture in health care? In what ways can safety be transferred – what concepts and tools have been incorporated from aviation safety?

The potential safety lessons that aviation has been providing for health care, along with how health care utilizes and incorporates them, can be found in a comparison of the FAA’s Aviation Safety Reporting System (ASRS) with the VA’s Patient Safety Reporting System (PSRS). Focusing upon the regulation of risk, the proposed paper presentation specifically compares Feedback, the PSRS publication, from that of Callback, the model ASRS publication. As general safety logics from aviation are re-articulated into health care settings, the paper presentation traces how aviation has been constituted as a model for safety culture in health care, discussing potential contradictions that this process of commensuration can have for regulating risk.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: In October 2004, the World Health Organization established the World Alliance for Patient Safety, a program that “raises awareness and political commitment to improve the safety of care and facilitates the development of patient safety policy and practice in all WHO member states” (www.who.int/patientsafety/). With this general goal of promoting patient safety, the Alliance has set forth a variety of specific action areas that attempt to extend knowledge, along with best practices, related to preventing and mitigating adverse events in healthcare delivery worldwide. In this conference paper, I trace the development and progress of the World Alliance’s action agenda, within a context of associated transnational patient safety initiatives, giving particular focus upon the effect that such global agendas and initiatives have for the governance of healthcare systems in Member States. Why has patient safety become a global health problem? How does international standardization improve patient care? What are the regulatory consequences for Member States?

In order to address such questions, I present a comparison of the World Alliance’s two Global Patient Safety Challenges, Clean Care is Safer Care and Safe Surgery Saves Lives. While noting some of the basic similarities (such as overall networking and reporting goals) and differences (such as type of intervention and timeframe) between the two campaigns, I call attention to how each promotes international safety standardization, and discuss the implications this has for the organization of healthcare systems.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Talk of safety culture has emerged as a common trope in contemporary scholarship and popular media as an explanation for accidents and as a recipe for improvement in complex socio-technical systems. In this paper, I review several conceptions of culture deployed in talk about safety: culture as cause, culture as learned reliability, and culture as emergent and indeterminant. Relying on a conception of culture as an indissoluble dialectic of system and practice, both the product and context of social action, I argue that the first two perspectives deploying standard causal logics fail to provide persuasive accounts, but also display affinities with individualist and reductionist epistemologies of neo-liberalism. Although invocation of the term safety culture seems to recognize and acknowledge systemic processes and effects, it is too often conceptualized so as to be measurable and manipulable, frequently operationalized specifically in terms of the attitudes and behaviors of individual actors, often the lowest level actors, with least authority, in the organizational hierarchy. The third category of culture as emergent and indeterminant serves as a critique of the claim that the presence and consequences of safety culture can be instrumentalized so as to confidently prevent unwelcome and catastrophic outcomes of complex technologies. The paper concludes by suggesting that research on safety in complex systems should explore just those features of complex organizations and technological systems that have been elided in the talk of safety culture: normative heterogeneity and cultural conflict; inequalities in power and authority; competing sets of interests within organizations.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: As welfare provisions and welfare rolls have been cut, imprisonment in the United States has climbed at an unprecedented rate. The co-occurrence of these patterns is likely not coincidence, especially if they are both viewed as mechanisms of social control in society. Indeed, previous studies of imprisonment have found that shifts in welfare provisions are associated with changes in prison admissions and custody rates. Research on welfare has examined whether partisan politics and economic factors predict changes in public assistance benefits and numbers of recipients. Yet, published research has not yet examined whether welfare and imprisonment policies are both accounted for by the same shifts in economic and political climates, and whether some aspects of economics and politics may have differential effects on the welfare safety net than on imprisonment. This is the goal of the present study. Using data from the fifty states for the late 1970s through 2004, we assess similarities and differences in the effects of economic, political and demographic factors on state welfare provisions versus state imprisonment rates. To assess these patterns, we develop an extension of the seemingly unrelated regression approach, recast in a multilevel modeling framework. The paper explores both the empirical and theoretical connections between the welfare safety net and concerns with public safety, in the form of imprisonment.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This paper presents some initial results of safety audits conducted in and around the University of Winnipeg’s campus in the late winter of 2005. Structured field observations were carried out by senior undergraduate students under the leadership of a faculty member in the Criminal Justice Studies program. While the ostensible objective of the audit was to highlight areas of concern and make recommendations based on the principles of Crime Prevention Through Environmental Design (CPTED), a secondary objective of the process was to provide students of Criminal Justice Studies with an opportunity for hands on learning.

The audit produced a number of concrete recommendations based on CPTED and more general principles derived from situational crime prevention. At the same time, the process also produced less tangible benefits to students as they applied abstract theory to concrete situations. This paper concludes by discussing the strengths and weaknesses of the safety audit process as a tool for both campus safety and criminal justice education.