The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan’s ‘Normalisation of Deviance’ provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an (...) insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five ‘serious untoward incidents’ occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing. Data sharing not applicable as no datasets generated and/or analysed for this study. (shrink)

In this 1970 introduction to philosophy Mr Taylor concentrates on two central topics - explanation and meaning. He takes the argument far enough to acquaint the reader first-hand with the methods and approach of analytical philosophy, and yet because of the scope of these two topics he is able to introduce many of the traditional philosophical problems in epistemology, metaphysics, ethics, aesthetics, and logic. By this approach he avoids the dangers both of superficiality and of undue technicality. Philosophers are concerned (...) to analyse and describe certain concepts and modes of argument, not to establish facts or conclusions of any sort that can be tested by formal demonstration or controlled observation; their findings cannot be conveniently categorized or graded into a comprehensive and progressive course of studies. Mr Taylor meets this difficulty with his extended discussions of specific topics and questions which have implications over the whole subject. (shrink)

In this 1970 introduction to philosophy Mr Taylor concentrates on two central topics - explanation and meaning. He takes the argument far enough to acquaint the reader first-hand with the methods and approach of analytical philosophy, and yet because of the scope of these two topics he is able to introduce many of the traditional philosophical problems in epistemology, metaphysics, ethics, aesthetics, and logic. By this approach he avoids the dangers both of superficiality and of undue technicality. Philosophers are concerned (...) to analyse and describe certain concepts and modes of argument, not to establish facts or conclusions of any sort that can be tested by formal demonstration or controlled observation; their findings cannot be conveniently categorized or graded into a comprehensive and progressive course of studies. Mr Taylor meets this difficulty with his extended discussions of specific topics and questions which have implications over the whole subject. (shrink)

We thank the commentators for their thoughtful engagement with our paper.1 In different ways, they make the same substantial point: our suggested interventions are not enough to solve the problems of organisational failure. On this we wholeheartedly agree. Organisational failure in healthcare is complex and multifaceted, it cannot be solved by one intervention in medical education. We did not intend to imply that our proposals alone would solve organisational failure, and this positioning misconstrues the aims of our paper. We had (...) more modest ambitions, we wanted to shift the analytical emphasis away from the individual and explore the implications raised by our analysis for our piece of the jigsaw—medical education. Having stepped away from such grand claims, the commentators make some valid points to which we would like to respond more specifically. Jesudason makes the distinction that normalisation of deviance (NoD) is well suited to understand institutional misfeasance but not malfeasance.2 We are inclined to agree; NoD can do some things but not all. Likewise, …. (shrink)

On 26 July 1240 Walter de Cantilupe, bishop of Worcester , held a diocesan synod in his cathedral church, where he issued a set of synodal statutes regulating the life and pastoral activities of his diocesan clergy. In calling this synod, Walter put himself in the company of many other prelates who sought to enact statutes in keeping with the reforming spirit of the Fourth Lateran Council of 1215. His statutes are comparable to those produced in many other dioceses during (...) the first decades of the thirteenth century. In one respect, however, Walter pursued an innovative path which he shared with a small group of contemporary English bishops during the 1230s and 1240s. These prelates, recognizing both the limitations of public assemblies and the potential for educating their clerics by means of written texts, supplemented their diocesan statutes with brief treatises designed to explain in more detail certain aspects of pastoral care. Alexander of Stavensby was probably the first to append such tracts; one treatise on confession and another on the seven deadly sins were circulated with his synodal statutes. (shrink)

Attentional control has grown in importance within theoretical and predictive models of psychopathology over past decades. The Attentional Style Questionnaire is a novel measure of internal a...