By John Tingle and Amanda Cattini
Every profession, service, or industry maintains what can be termed, “buzzwords.” A “buzzword” can be defined as transient, flavor-of-the-month-type word, which describes a concept than can be seen to direct policy and practice until it becomes less topical and eventually fades away from general use. These terms come and go and are often refined and come back into use. In the National Health Service (NHS) in England, we have seen such pervading terms as clinical governance, patient empowerment, controls assurance, and patient advocacy.
Today there is what can arguably be called a new buzzword, “decolonization.” This word seems very much to be the term of the day. It pervades vast areas of academic and professional life and discourse. In terms of health law and patient safety research, the decolonization of national and global patient safety systems and structures seems an interesting perspective to further peruse.
One benefit of adopting decolonization perspectives to patient safety is that we can utilize the concept as a disrupter of established thinking and seek to establish new foundations of knowledge.
We can talk about the decolonization of almost any subject. There are many competing definitions of the term with wide and narrow meanings. The University of Warwick, Education Studies has this helpful definition:
“Decolonisation itself refers to the undoing of colonial rule over subordinate countries but has taken on a wider meaning as the ‘freeing of minds from colonial ideology’ in particular by addressing the ingrained idea that to be colonised was to be inferior. Decolonisation then offers a powerful metaphor for those wanting to critique positions of power and dominant culture.”
The patient safety context
Applying the term to the patient safety context, we could consider whether some professional groups are more powerful than others in hospitals and in patient safety policy making. And how representative are these groups in terms of ethnicity, age, gender?
Other issues could include: discussing the pervading blame culture in health care delivery when adverse health care events occur; bullying in the workplace; patient participation and involvement in patient safety policy development and in investigations. We also need to question who sits on Government, arm’s length patient safety, health regulator, and health quality boards and advisory panels.
Do the same people sit on these? Where are patient safety regulators, arm’s length bodies, and other government and global organizations getting their patient safety advice and research from? Is it the same or similar organizations?
Our underpinning patient safety systems, modelling, and framework are crafted too much on Eurocentric viewpoints. We can have much to learn from other systems of thought, knowledge, and ethics.
Problems of definition
Decolonization is a concept that has multiple, specific meanings. In thinking about conceptual clarity in the patient safety context, it may be advantageous to draw on essential tenets of the concept to identify and deploy other words which have more open meanings.
Words such reflect, declutter, reappraise, and reset may be better words to use when talking about some patient safety and health quality issues in the NHS in England as they have less established meanings, but they also share conceptual similarities with decolonization.
We also need to reflect on whether the decolonization movement in patient safety and global health needs decolonization itself (see further the discussion by Ijeoma Nnodim Opara).