Rapport Patiëntveiligheid, de rol van de bestuurder - Veilige zorg ...

Side-effects of professionalismThe fourth trait that was identified is the fact that the problem is linked toseveral negative side-effects of professionalism. Healthcare professionals areresponsible for the safety of their patients and feel strongly that way. Thispositive characteristic has a negative side-effect: physicians see their autonomyas an unconditional requirement for delivering good care. As in otherprofessional groups, such as judges, autonomy has created a culture inwhich it is not easy to correct each other. There are many painful recentexamples of dysfunctional physicians who could continue their practice foryears without being corrected by their peers, despite them being all tooaware of the problem. If the professionals keep silent, the board often onlyfinds out there is a problem when it has already escalated.These four traits are particularly interesting for this research because boardscan hardly influence them. A board member cannot make all safety problemsvisible, lacks the knowhow to solve the ambiguity and diversity and isnot able to change professional culture and norms. Despite this, he has alegal obligation to ensure safe health care within his own organization.Theory part 2 – leading professional organizationsBesides the difficulties due to inherent traits of the patient safety problem,leading patient safety improvements confronts boards with another majordifficulty: the problems take place within a professional organization.Leading professionals is an ambivalent task. On the one hand professionalsdo not need board level leadership: they have all the required knowledge andskills to perform their tasks, they are intrinsically motivated, they are autonomousand internal rules and networks lead to strong social control. On theother hand these characteristics are themselves sometimes causes of unsafetyin healthcare and make board level leadership essential to prevent harm.Patient safety is a typical example of the kind of problems that professionalorganizations are confronted with. Both the information about the problemand the way this information should be interpreted, are open to discussion.This makes patient safety an “unstructured” problem.Leading patient safety improvements is one of the most complex tasks aboard has to fulfill, because:- The board is dependent upon a diverse group of highly trained, autonomousprofessionals;Patiëntveiligheid, de rol van de bestuurder 383