Stress, anxiety, and erosion of trust: maternity staff experiences with incident management.

BACKGROUND: Adverse incidents in maternity care and other healthcare systems continue to be a major cause of morbidity and mortality, with significant financial costs to healthcare organizations, patients, and their families. Over the last decades, healthcare organizations have focused their attention on improving the quality of patient care, safety, and experience. However, very little attention has been given to understanding and improving staff experience. This is despite the high probability that healthcare professionals who experience their workplace positively will deliver higher-quality care, report incidents more commonly, and actively engage in incident investigation and learning processes. OBJECTIVE: This study aimed to explore maternity staff's experiences with the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and the organizational process. STUDY DESIGN: Semistructured in-depth qualitative interviews were analyzed using a methodological procedure for understanding human experiences of complex social phenomena (interpretive phenomenological analysis). The study was conducted in a tertiary university maternity teaching hospital in England with approximately 6000 deliveries per annum. A purposive sample of 10 staff members (2 consultants, 3 specialist registrars, and 5 midwives) was selected, with all participants having been involved in incidents requiring formal investigation during the preceding 12 months. The main outcome measures were the lived experiences, emotions, and perceptions regarding how the incident reporting and investigation process affected their trust in risk management leadership and the organizational process. RESULTS: Incident reporting and investigation were found to be perceived by staff members as very stressful events with no structured feedback and support system for staff. We found that this led to diminished trust in risk management leadership and the organizational process, with staff relying on colleagues for support and validation of their practice. CONCLUSION: The study showed that poorly managed processes of incident reporting and investigation result in diminished trust in risk management leadership and organizational processes. It also reinforced the understanding that adverse incidents have a profound impact on the mental health and well-being of healthcare professionals. Factors that could likely mitigate these experiences and effects include: (1) timely updates and feedback from incident investigation; (2) high levels of leadership visibility; and (3) structured support for staff during and after incident reporting and investigations.

Coalitions of touch: Balancing restraint and haptic soothing in the veterinary clinic.

This article responds to recent calls to further incorporate the study of animal health care into the sociology of health and illness. It focuses on a theme with a long tradition in medical sociology, namely clinical communication, but explores matters distinctive to veterinary practice. Drawing on video recordings of 60 consultations across three small animal veterinary clinics in the United Kingdom, we explore how clients and veterinarians (or "vets") fashion fleeting "coalitions of touch," that aptly position the animal to enable the performance of medical work, often in the face of physical resistance. Building on recent developments in the study of haptic sociality, we analyse how care and emotional concern for animal patients is communicated through various forms of embodied action; thus, how the problematics of forced care and restraint are mitigated through distinctive ways of touching and holding animal patients. Moreover, while prior studies of small animal veterinary work have highlighted the significance of talk within the clinician-animal-client triad, we reveal the fundamentally embodied and collaborative work of managing and controlling patients during sometimes intense and fast-moving episodes of veterinary care.

Streetwise sales and the social order of city streets.

This paper analyses how a Big Issue vendor approached passers-by and how they responded, how recognizable courses of social and economic activity were interactionally produced from initiation through to some conclusion. The paper recovers how the vendor's work was contextually embedded in the urban landscape, how it was constrained by, and actively shaped, the social order of the street. Drawing on video-audio recordings the paper contributes to a growing body of ethnographic and ethnomethodological research which has emphasized the embodied, contingent and interactional character of economic activity. By examining such materials, the paper is well positioned to describe how the vendor found his market on the street, social interventions that propelled passers-by into buying behaviour. The paper sheds light on now familiar encounters which occur millions of times each week in the UK and beyond.