Critical Incident Reporting and the Discursive Reconfiguration of Feeling and Positioning
DOI:
https://doi.org/10.1558/japl.v2.i3.325Keywords:
clinical incident reports, appraisal, positioningAbstract
This article analyses the emotional and generic dimensions of critical incident reports. These incident reports have been selected from the specialty of retrieval medicine; that is, a specialized service that transports patients from distant accident sites to hospitals. With its focus on emergencies in distant locations, this area of medicine and the care it provides is a hothouse for procedural difficulties, medical complications and, therefore, emotive language. The analysis demonstrates, firstly, that these reports can contain a range of evaluative expressions, including personal and depersonalized affect, interpersonal and normative udgements, and assessments of the functionality of objects. Secondly, these evaluations frequently harbour a tension between informal (private, emotional, self-oriented) and formal (public, depersonalized, formalized) discourse. Thirdly, the overall structure of incident reports is such as to effect a complex discursive transformation from personal sentiments into organizational assessments and solutions. The article concludes that incident reporting is an important postbureaucratic technique, in that it creates a space where clinicians are invited to link experiential dilemmas to service redesign strategies, and display their commitment to the ethos and practices of organizational improvement.
References
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Carroll, R. (2004) Risk Management Handbook for Health Care Organizations. San Francisco: Jossey-Bass.
Damasio, A. (2003) Looking for Spinoza: joy, sorrow and the feeling brain. London: Vintage.
Davies, B. and Harré, R. (1990) Positioning: the discursive production of selves. Journal for the Theory of Social Behaviour 20(1): 43–63.
De Rosier, J., Stalhanske, E., Bagian, J. P., et al. (2002) Using health care failure mode and effect analysis: the prospective risk analysis system. Joint Commission Journal on Quality Improvement 28: 248–267.
Degeling, P., Hill, M. and Kennedy, J. (2001) Mediating the cultural boundaries between medicine, nursing and management – the central challenge in hospital reform. Health Services Management Research 14(1): 36–48.
Degeling, P., Sorensen, R., Maxwell, S., Aisbett, C., Zhang, K. and Coyle, B. (2001) The Organisation of Hospital Care and its Effects. Sydney: Centre for Hospital Management and Information Systems Research, The University of New South Wales.
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Esmail, A. (2006) Clinical perspectives on patient safety. In K. Walshe and R. Boaden (eds) Patient Safety: research into practice 9–18. Maidenhead: Open University Press.
Fineman, S. (1996) Emotion and organizing. In S. Clegg, C. Hardy and W. Nord (eds) Handbook of Organization Studies 543–564. London: Sage.
Flabouris, A. (2003) A description of events associated with scene response by helicopterbased medical retrieval teams. Sydney: NRMA CareFlight.
Flanagan, J. C. (1954) The critical incident technique. Psychological Bulletin 51: 327–358.
Fleishman, S. (2003) Language and medicine. In D. Schiffrin, D. Tannen and H. E. Hamilton (eds) The Handbook of Discourse Analysis 470–502. Oxford: Blackwell.
Freidson, E. (1994) Professionalism Reborn: theory, prophesy and policy. Cambridge: Polity Press.
Grant, S. and Iedema, R. (2004) Attitiudinal meaning in critical incident reports. Australian Systemic Functional Linguistics Association. Brisbane 27 June 2004.
Hoggett, P. (1991) A new management in the public sector. Policy and Politics 19(4).
Hunston, S. and Thompson, G. (2000) Evaluation in Text: authorial stance and the construction of discourse. Oxford: Oxford University Press.
Hunter, C. (2006) Untangling the web of critical incidents: ethnography in a paediatric setting. The Annual Australian Anthropology Association Conference. Cairns.
Iedema, R. (1996) The Language of Administration (‘Write it Right’ industry research report vol. III). Erskinville, Sydney: Disadvantaged Schools Program (Metropolitan East).
Iedema, R. (2003) Discourses of Post-Bureaucratic Organization. Amsterdam, Philadelphia: John Benjamins.
Iedema, R. (2006) (Post-)bureaucratizing medicine: health reform and the reconfiguration of contemporary clinical work. In F. Meyer and M. Gotti (eds) Advances in Medical Discourse Analysis: oral and written contexts 111–131. Gottingen: Peter Lang.
Iedema, R., Flabouris, A., Grant, S. and Jorm, C. M. (2006a) Narrativizing errors of care: critical incident reporting in clinical practice. Social Science & Medicine 62(1): 134–144.
Iedema, R. and Grant, S. (2004) AIMS Retrieval Medicine Incident Reporting: an investigation of reporters’ expressions of attitude and feeling. Sydney: Centre for Clinical Governance Research, The University of New South Wales.
Iedema, R., Jorm, C. M., Braithwaite, J., Travaglia, J. and Lum, M. (2006b) A root cause analysis of clinical errors: confronting the disjunction between formal rules and situated clinical activity. Social Science & Medicine 63(5): 1201–1212.
Iedema, R., Jorm, C. M., Long, D., Braithwaite, J., Travaglia, J. and Westbrook, M. (2006c) Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. Social Science & Medicine 62(7): 1605–1615.
Lamb, R. (2004) Open disclosure: the only approach to medical error. Quality and Safety in Health Care 13(2004): 3–5.
Mangham, I. (1998) Emotional discourse in organizations. In D. Grant, T. Keenoy and C. Oswick (eds) Discourse and Organization 51–64. London: Sage Publications.
Martin, J. (2004) Mourning: how we get aligned. Discourse & Society 15(2–3): 321–344.
Martin, J. R. (2000) Beyond exchange: appraisal systems in English. In S. Hunston and G. Thompson (eds) Evaluation in Text: authorial stance and the construction of discourse 142–175. Oxford: Oxford University Press.
Martin, J. R. (2003) Introduction (A special issue on Appraisal). Text 23(2): 171–181.
Martin, J. R. and Rose, D. (2004) Working with Discourse: meaning beyond the clause. London: Continuum.
Martin, J. R. and White, P. R. R. (2005) The Language of Evaluation, Appraisal in English. London and New York: Palgrave Macmillan.
Maynard, S. (2002) Linguistic Emotivity: centrality of place, the topic-comment dynamic and an ideology of pathos in Japanese discourse. Amsterdam and Philadelphia: John Benjamins.
Neily, J., Ogrinc, G., Mills, P., Williams, R., Stalhandske, E., Bagian, J. and Weeks, W. B. (2003) Using aggregate root cause analysis to improve patient safety. Joint Commission Journal on Quality and Safety 29(8): 434–439.
Plsek, P. and Greenhalgh, T. (2001) The challenge of complexity in health care. British Medical Journal 323: 625–628.
Rorty, R. (1980) Philosophy and the Mirror of Nature. Oxford: Blackwell.
Rose, N. (1999) Powers of Freedom: reframing political thought. Cambridge: Cambridge University Press.
Runciman, W. B., Webb, R. K., Helps, S. C., Thomas, E. J., Sexton, E. J., Studdert, D. M. and Brennan, T. A. (2000) A comparison of iatrogenic injury studies in Australia and the USA II: reviewer behaviour and quality of care. International Journal for Quality in Health Care 12(5): 379–388.
Runciman, W. B., Webb, R. K., Lee, R. and Holland, R. (1993) The Australian incident monitoring study: system failure – an analysis of 2000 incident reports. Anaesthetic Intensive Care 21(5): 684–695.
Sarangi, S. and Roberts, C. (1999) Talk, Work and the Institutional Order: discourse in medical, mediation and management settings. Berlin and New York: Mouton de Gruyter.
Schatzki, T. (2002) The Site of the Social. University Park, Penn.: The Pennsylvania State University Press.
Short, T., O’Regan, A., Jayasuriya, J. P., Rowbottom, M., Buckley, T. A. and Oh, T. E. (1996) Improvements in anaesthetic care resulting from a critical incident reporting programme. Anaesthesia 51(7): 615–621.
Shotter, J. and Gergen, K. (1989) Texts of Identity. Newbury Park: Sage.
UK Department of Health/Design Council (2003) Design for Patient Safety: a system-wide design-led approach to tackling patient safety in the NHS. London: Department of Health.
Webb, R. K., Van der Walt, J. H., Runciman, W. B., Williamson, J. A., Cockings, J., Russell, W. J. and Helps, S. (1993) Which monitor? An analysis of 2000 incident reports. Anaesthetic Intensive Care 21(5): 529–542.
White, P. R. R. (2002) Appraisal – the language of evaluation and stance. In J. Verschueren, J. Östman, J. Blommaert and C. Bulcaen (eds) The Handbook of Pragmatics 1–27. Amsterdam and Philadelphia: John Benjamins Publishing Co.
White, P. R. R. (2003) Beyond modality and hedging: a dialogic view of the language of intersubjective stance. Text 23(2): 259–284.
Whorf, B. L. (1956) Language, thought and reality. Selected writings of Benjamin Lee Whorf. In J. B. Carroll (ed.) Mass.: MIT Press.
Wilson, R., Runciman, W. B., Gibberd, R. W., Harrison, B., Newby, L. and Hamilton, J. (1995) The quality in Australian health care study. The Medical Journal of Australia 163(9): 458–471.
Ashkanasy, N. M. (2003) Emotions in organizations. In F. Dansereau and F. Yammarino (eds) Multi-level Issues in Organizational Behaviour and Strategy 9–54. Amsterdam and New York: JAI Press.
Bagian, J. P., Gosbee, J., Lee, C. Z., Williams, L., McKnight, S. D. and Mannos, D. M. (2002) The Veterans Affairs root cause analysis system in action. Journal on Quality Improvement 28: 531–545.
Barker, C. (2000) Cultural Studies: theory and practice. London: Sage.
Beckmann, U., Baldwin, I., Hart, G. K. and Runciman, W. B. (1996) The Australian incident monitoring study in intensive care: AIMS-ICU – an analysis of the first year of reporting. Anaesthetic Intensive Care 24(3): 320–329.
Bernstein, B. (1987) Social class, codes and communication. In U. Ammon, N. Dittmar and K. J. Mattheier (eds) Sociolinguistics: an international handbook of the science of society Volume I. Berlin-New York: de Gruyter.
Biber, D. (1995) Dimensions of Register Variation: a cross-linguistic comparison. Cambridge: Cambridge University Press.
Braithwaite, J., Travaglia, J., Westbrook, M. T., Jorm, C., Hunter, C., Carroll, K., Iedema, R. and Ekambareshwar, M. (2006) Overview Report On The Evaluation Of The Incident Information Management System. Sydney: Centre for Clinical Governance Research.
Brennan, T. A., Leape, L. L., Laird, M. M., Nan, M., Hebert, L., Localio, A. R., Lawthers, A. G., Newhouse, J., P., Weiler, P. C. and Hiatt, H. H. (1991) Incidence of adverse events and negligence in hospitalized patients: results of the Harvard medical practice study. New England Journal of Medicine 324: 370–376.
Carroll, R. (2004) Risk Management Handbook for Health Care Organizations. San Francisco: Jossey-Bass.
Damasio, A. (2003) Looking for Spinoza: joy, sorrow and the feeling brain. London: Vintage.
Davies, B. and Harré, R. (1990) Positioning: the discursive production of selves. Journal for the Theory of Social Behaviour 20(1): 43–63.
De Rosier, J., Stalhanske, E., Bagian, J. P., et al. (2002) Using health care failure mode and effect analysis: the prospective risk analysis system. Joint Commission Journal on Quality Improvement 28: 248–267.
Degeling, P., Hill, M. and Kennedy, J. (2001) Mediating the cultural boundaries between medicine, nursing and management – the central challenge in hospital reform. Health Services Management Research 14(1): 36–48.
Degeling, P., Sorensen, R., Maxwell, S., Aisbett, C., Zhang, K. and Coyle, B. (2001) The Organisation of Hospital Care and its Effects. Sydney: Centre for Hospital Management and Information Systems Research, The University of New South Wales.
Deleuze, G. (1978) Le Cours de Gilles Deleuze: Spinoza (trans. T. S. Murphy). Available from: http://www. webdeleuze. com/php/texte. php?cle=14&groupe=Spinoza&langue=2. Accessed 2 January 2005.
Drew, P. and Heritage, J. (1992) Talk at Work: interaction in institutional settings. Cambridge: Cambridge University Press.
Ellis, J. M. (1994) Language, Thought and Logic. Evanston, Ill.: Northwestern University Press.
Esmail, A. (2006) Clinical perspectives on patient safety. In K. Walshe and R. Boaden (eds) Patient Safety: research into practice 9–18. Maidenhead: Open University Press.
Fineman, S. (1996) Emotion and organizing. In S. Clegg, C. Hardy and W. Nord (eds) Handbook of Organization Studies 543–564. London: Sage.
Flabouris, A. (2003) A description of events associated with scene response by helicopterbased medical retrieval teams. Sydney: NRMA CareFlight.
Flanagan, J. C. (1954) The critical incident technique. Psychological Bulletin 51: 327–358.
Fleishman, S. (2003) Language and medicine. In D. Schiffrin, D. Tannen and H. E. Hamilton (eds) The Handbook of Discourse Analysis 470–502. Oxford: Blackwell.
Freidson, E. (1994) Professionalism Reborn: theory, prophesy and policy. Cambridge: Polity Press.
Grant, S. and Iedema, R. (2004) Attitiudinal meaning in critical incident reports. Australian Systemic Functional Linguistics Association. Brisbane 27 June 2004.
Hoggett, P. (1991) A new management in the public sector. Policy and Politics 19(4).
Hunston, S. and Thompson, G. (2000) Evaluation in Text: authorial stance and the construction of discourse. Oxford: Oxford University Press.
Hunter, C. (2006) Untangling the web of critical incidents: ethnography in a paediatric setting. The Annual Australian Anthropology Association Conference. Cairns.
Iedema, R. (1996) The Language of Administration (‘Write it Right’ industry research report vol. III). Erskinville, Sydney: Disadvantaged Schools Program (Metropolitan East).
Iedema, R. (2003) Discourses of Post-Bureaucratic Organization. Amsterdam, Philadelphia: John Benjamins.
Iedema, R. (2006) (Post-)bureaucratizing medicine: health reform and the reconfiguration of contemporary clinical work. In F. Meyer and M. Gotti (eds) Advances in Medical Discourse Analysis: oral and written contexts 111–131. Gottingen: Peter Lang.
Iedema, R., Flabouris, A., Grant, S. and Jorm, C. M. (2006a) Narrativizing errors of care: critical incident reporting in clinical practice. Social Science & Medicine 62(1): 134–144.
Iedema, R. and Grant, S. (2004) AIMS Retrieval Medicine Incident Reporting: an investigation of reporters’ expressions of attitude and feeling. Sydney: Centre for Clinical Governance Research, The University of New South Wales.
Iedema, R., Jorm, C. M., Braithwaite, J., Travaglia, J. and Lum, M. (2006b) A root cause analysis of clinical errors: confronting the disjunction between formal rules and situated clinical activity. Social Science & Medicine 63(5): 1201–1212.
Iedema, R., Jorm, C. M., Long, D., Braithwaite, J., Travaglia, J. and Westbrook, M. (2006c) Turning the medical gaze in upon itself: root cause analysis and the investigation of clinical error. Social Science & Medicine 62(7): 1605–1615.
Lamb, R. (2004) Open disclosure: the only approach to medical error. Quality and Safety in Health Care 13(2004): 3–5.
Mangham, I. (1998) Emotional discourse in organizations. In D. Grant, T. Keenoy and C. Oswick (eds) Discourse and Organization 51–64. London: Sage Publications.
Martin, J. (2004) Mourning: how we get aligned. Discourse & Society 15(2–3): 321–344.
Martin, J. R. (2000) Beyond exchange: appraisal systems in English. In S. Hunston and G. Thompson (eds) Evaluation in Text: authorial stance and the construction of discourse 142–175. Oxford: Oxford University Press.
Martin, J. R. (2003) Introduction (A special issue on Appraisal). Text 23(2): 171–181.
Martin, J. R. and Rose, D. (2004) Working with Discourse: meaning beyond the clause. London: Continuum.
Martin, J. R. and White, P. R. R. (2005) The Language of Evaluation, Appraisal in English. London and New York: Palgrave Macmillan.
Maynard, S. (2002) Linguistic Emotivity: centrality of place, the topic-comment dynamic and an ideology of pathos in Japanese discourse. Amsterdam and Philadelphia: John Benjamins.
Neily, J., Ogrinc, G., Mills, P., Williams, R., Stalhandske, E., Bagian, J. and Weeks, W. B. (2003) Using aggregate root cause analysis to improve patient safety. Joint Commission Journal on Quality and Safety 29(8): 434–439.
Plsek, P. and Greenhalgh, T. (2001) The challenge of complexity in health care. British Medical Journal 323: 625–628.
Rorty, R. (1980) Philosophy and the Mirror of Nature. Oxford: Blackwell.
Rose, N. (1999) Powers of Freedom: reframing political thought. Cambridge: Cambridge University Press.
Runciman, W. B., Webb, R. K., Helps, S. C., Thomas, E. J., Sexton, E. J., Studdert, D. M. and Brennan, T. A. (2000) A comparison of iatrogenic injury studies in Australia and the USA II: reviewer behaviour and quality of care. International Journal for Quality in Health Care 12(5): 379–388.
Runciman, W. B., Webb, R. K., Lee, R. and Holland, R. (1993) The Australian incident monitoring study: system failure – an analysis of 2000 incident reports. Anaesthetic Intensive Care 21(5): 684–695.
Sarangi, S. and Roberts, C. (1999) Talk, Work and the Institutional Order: discourse in medical, mediation and management settings. Berlin and New York: Mouton de Gruyter.
Schatzki, T. (2002) The Site of the Social. University Park, Penn.: The Pennsylvania State University Press.
Short, T., O’Regan, A., Jayasuriya, J. P., Rowbottom, M., Buckley, T. A. and Oh, T. E. (1996) Improvements in anaesthetic care resulting from a critical incident reporting programme. Anaesthesia 51(7): 615–621.
Shotter, J. and Gergen, K. (1989) Texts of Identity. Newbury Park: Sage.
UK Department of Health/Design Council (2003) Design for Patient Safety: a system-wide design-led approach to tackling patient safety in the NHS. London: Department of Health.
Webb, R. K., Van der Walt, J. H., Runciman, W. B., Williamson, J. A., Cockings, J., Russell, W. J. and Helps, S. (1993) Which monitor? An analysis of 2000 incident reports. Anaesthetic Intensive Care 21(5): 529–542.
White, P. R. R. (2002) Appraisal – the language of evaluation and stance. In J. Verschueren, J. Östman, J. Blommaert and C. Bulcaen (eds) The Handbook of Pragmatics 1–27. Amsterdam and Philadelphia: John Benjamins Publishing Co.
White, P. R. R. (2003) Beyond modality and hedging: a dialogic view of the language of intersubjective stance. Text 23(2): 259–284.
Whorf, B. L. (1956) Language, thought and reality. Selected writings of Benjamin Lee Whorf. In J. B. Carroll (ed.) Mass.: MIT Press.
Wilson, R., Runciman, W. B., Gibberd, R. W., Harrison, B., Newby, L. and Hamilton, J. (1995) The quality in Australian health care study. The Medical Journal of Australia 163(9): 458–471.
Published
2008-04-11
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Equinox Publishing Ltd.
How to Cite
Iedema, R. (2008). Critical Incident Reporting and the Discursive Reconfiguration of Feeling and Positioning. Journal of Applied Linguistics and Professional Practice, 2(3), 325-349. https://doi.org/10.1558/japl.v2.i3.325
