Analysing the emergence of risk : - an opportunity for patient safety

Abstract: The notion of patient safety entails protecting patients from preventable harm. This thesis presents suggestions on how the healthcare system, notably psychiatric healthcare, can understand and analyse patient safety risk as an emergent property of everyday interactions and relations. This view has itsconceptual roots in complexity theory.The overall aim is to understand patient safety risk as an emergent property, and how risk can be analysed using patient visits to a psychiatric healthcare facility, based on a holistic approach. Four studies are presented, and two main research questions are asked.The first research question is addressed through a scoping review, and the second (along with three subquestions) uses a psychiatric clinic as a case study to analyse patient visit patterns over time. This thesis suggests that increased patient safety requires an understanding of interactions between multiple systemlevels, with a focus on how risk emerges from performance variability, adaptive capacities and changing conditions over time. It proposes new methods for analysing and interpreting dynamic emergent risk in psychiatric healthcare.The methods used in Paper II, III, and IV illustrate how patient visit patterns can be used to analyse emerging risks in the healthcare system. The results help to create an understanding of how patient safety risk is dynamic and changes over time. Overall, the thesis provides a conceptual framework for mapping sourcesof adaptive capacities and performance variability, together with the risk emerging from their interactions. This knowledge can be used to create new forms of feedback from the meso to the micro level (e.g. via electronic medical records), which, in turn, could increase patient safety.