Big data problems we face today can be traced to the social ordering practices of the 19th century.

In the 19th century, changes in knowledge were facilitated not only by large quantities of new information pouring in from around the world but by shifts in the production, processing and analysis of that information. Hamish Robertson and Joanne Travaglia trace the connections between the 19th century data revolution and the present day one, outlining the implications this may have for the politics of big data in contemporary society. Two centuries after the first big data revolution, many of the problems and their solutions persist down to the present era

The necropolitics of COVID-19: will the COVID-19 pandemic reshape national healthcare systems?

The COVID-19 pandemic has made necropolitics – the politics of life and death – unavoidable . Drawing on the work of Achille Mbembe, Hamish Robertson and Joanne Travaglia argue that, as in previous crises, COVID-19 reveals many of the hidden assumptions underpinning national healthcare systems. As the current crisis continues to bring these assumptions into the mainstream and disrupts business as usual, they suggest that COVID-19 points towards opportunities to reshape the relationship of society to its most vulnerable members

Without a critical approach to big data it risks becoming an increasingly sophisticated paradigm for coercion

We are in the midst of a data revolution, one reliant on the capture, analysis, and visual representation of enlarged quantitative data, in increasingly digital formats. Hamish Robertson and Joanne Travaglia argue that big data quantification is now not only a mechanism for extracting information but has become an idea with social and political power in its own right. The lack of critique of quantitative methods and their application contributes to the existing and potentially coercive power of digital information systems and their attendant methods, and enhances the potential for “collateral damage” associated with such applications

Social Work Leadership for Patient Safety

Social workers are rarely considered as key personnel in the field of patient safety. The clinical nature of many, if not most, errors means that it is much more likely that doctors, nurses and pharmacists are involved both in the errors themselves and in attempts to improve the quality and safety of care. Yet, despite best efforts around the world for the last two decades the overall rate of errors has not decreased. In this chapter I argue that there is great potential for social work leadership to improve the quality and safety of care for patients and clients, and in particular for vulnerable individuals and groups. One way of understanding this potential is through the lens of a social epidemiology of patient safety, which can then be linked to the competencies required by social workers in leading this new approach to patient/client safety and quality improvement. Drawing on evidence both from research and from patient safety inquiries around the world, I look at how the social context and status of patients contributes to errors, particularly of vulnerable individuals and groups, and the unique leadership role that social workers can take in preventing and responding to errors and adverse events

Disturbing the Doxa of Patient Safety; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”

In a recent edition of this journal, Mannion and Braithwaite provide a succinct analysis of the emergence, and ultimately limited impact, of what they term the current ‘Safety I’ movement in healthcare. They describe the arc of this field from denial, through engagement via mechanisms and approaches imported from other industries, to the current situation where, despite ‘best efforts,’ error rates remain stubbornly recalcitrant. In examining the failure of system-wide efforts to produce sustained reductions in errors and adverse events, that article exposes the doxa, or what Bourdieu calls ‘the taken for granted’ which is central to this latest wave of patient safety movement. In this commentary, I would like to take focus on two key elements of Mannion and Braithwaite’s argument: that harm is caused by misguided but otherwise well-intentioned actions and the ‘embracing’ of patient safety. I then conclude by briefly considering the implications of these for Safety II, particularly as envisaged by the authors as an evolutionary, and therefore linear progression, from Safety I

Disturbing the Doxa of Patient Safety Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”

Abstract In a recent edition of this journal, Mannion and Braithwaite provide a succinct analysis of the emergence, and ultimately limited impact, of what they term the current ‘Safety I’ movement in healthcare. They describe the arc of this field from denial, through engagement via mechanisms and approaches imported from other industries, to the current situation where, despite ‘best efforts,’ error rates remain stubbornly recalcitrant. In examining the failure of system-wide efforts to produce sustained reductions in errors and adverse events, that article exposes the doxa, or what Bourdieu calls ‘the taken for granted’ which is central to this latest wave of patient safety movement. In this commentary, I would like to take focus on two key elements of Mannion and Braithwaite’s argument: that harm is caused by misguided but otherwise well-intentioned actions and the ‘embracing’ of patient safety. I then conclude by briefly considering the implications of these for Safety II, particularly as envisaged by the authors as an evolutionary, and therefore linear progression, from Safety I

General Practice from the perspective of a Learning Organisation

The focus of the study is situated in future directions for the health care of NSW residents. Across the world and in Australia it has been recognised that more emphasis needs to be placed on primary care with the goal of improving health outcomes and reducing health costs and health inequities. With the need to reposition the Australian healthcare workforce in response to federal health reforms and in order to meet the primary healthcare needs of future populations a key strategy of NSW 2021 is preventive health and effective management of chronic disease. The general practice microsystem is at the forefront of service provision. A narrative literature review technique was conducted to discuss and synthesise ideas concerning the application and enactment of learning organisation theory in Australia particularly regarding general practice microsystems. A narrative literature review offers the advantage of integrating qualitative and quantitative evidence and providing a broad coverage of issues on a topic. In order to overcome the perceived shortcomings of narrative reviews such as bias and lack of transparency, concepts investigated, search terminology used and inclusion and exclusion criteria for articles selected are carefully and succinctly explained. A mixed method approach was chosen for the study as it incorporates the use of qualitative and quantitative strategies and results in collection of data that represents differing lenses, perspectives and viewpoints. Quantitative data collection included data from staff (administrative, nurses and doctors), practice managers and patient questionnaires while qualitative data was derived from staff and practice manager interviews.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Patient Safety and People Who Are Incarcerated

We explore a number of key relationships between patient safety and the health status of imprisoned people. This is a conceptual study drawing connections between a number of literatures including the field of patient safety, the work done on health and illness amongst imprisoned people, their social characteristics, and the carceral environment itself. We show that this is an underexplored and under-theorised field of inquiry. It also sets the scene for further investigation of not only individual and systemic factors in the health and illness experienced by such people but the role of the carceral environment. It seems clear that the risk of ill-health rises for many people who are incarcerated. Errors of both omission and commission are common in carceral environments. Risks rise for patients in such environments due to delays in diagnosis, referral and treatment. Understanding the complex and inter-related factors that increase ill-health in individuals, groups and communities provides a starting point for understanding why, when and how imprisoned people need to access and utilise healthcare, how will they are when they do so, and how. It also opens up the question of how these factors might affect their susceptibility to medical errors and adverse events

Improving quality through clinical governance in primary health care

Ensuring health care that is safe and of high quality is as much a priority for the primary care sector as it is for hospitals. The National Health and Hospital Reform Commission has made a number of recommendations which foreground the need for accountable services that have overarching quality improvement systems. However, attempts to integrate quality assurance and improvement programs into the everyday work of the Australian primary care sector must contend with the diversity of service types, the lack of systematised communication within and between these service types, and variation of managerial structures. This review explores clinical governance, a systematic and integrated approach to ensuring services are accountable for delivering quality services. Clinical governance as a policy framework was part of the National Health Service reforms of the early 1990s, but similar initiatives have also been developed in the US and Europe. The applicability of these initiatives to the diverse Australian primary care sector has not previously been studied.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

The Legal Needs of People Living with a Sexually Transmissible Infection or Blood-Borne Virus: Perspectives From a Sample of the Australian Sexual Health and Blood Borne Virus Workforce

Law and the legal environment are important factors in the epidemiology and prevention of sexually transmissible infections (STIs) and blood-borne viruses (BBVs). However, there has been no sustained effort to monitor the legal environment surrounding STIs and BBVs. This article presents the first data on the incidence and impacts of unmet legal needs for those affected by an STI or BBV in Australia using a survey administered to a sample of the Australian sexual health and BBV workforce. Migration, Housing, Money/Debt, Health (including complaints about health services), and Crime (accused/offender) were reported as the five most common legal need areas, with 60% of respondents describing these legal problems as generating a “severe” impact on health. These results indicate that unmet legal needs generate significant negative impacts in terms of individual health, on public health, and the ability to provide sustainable services such as testing and treatment to those facing unmet legal needs