Journal article
Defensive decoupling: Tensions and contradictions in a US surgical safety intervention
Social science & medicine (1982), v 403, 119421
01 Aug 2026
PMID: 42214254
Abstract
Physicians have the professional mandate to lead patient safety reform in their local health settings. Yet, research finds physicians may seek to disrupt safety reform and decouple the initiative from clinical work routines. This form of ritualism is attributed to jurisdictional disputes and threats to physician authority between physicians and other frontline occupations. In this article, we set out to examine organizational and professional factors driving ritualism over the course of a three-year safety intervention (2013-2015) in two US surgical departments. The intervention design included a longitudinal qualitative study of project processes and outcomes, interviewing physicians, nurses and technicians, and administrators about their experiences of the reform. A key finding from the case comparison was physicians may not always perceive quality improvement to be aligned with their professional mission. We introduce the term defensive decoupling, an extension of defensive medicine from doctor-patient relationships to patient safety reform. In response to threats from regulatory sanctions and risk of medical liability, surgeons retreat from patient safety reform. Our findings highlight the unique tensions faced by community hospitals in medically underserved settings, where safety reform is perceived by physicians as a form of social control and undermined trust in the profession.
•Quality improvement (QI) is not always aligned with physician's professional mission.•Patient safety regulation brings the risk of sanctions or medical liability.•Physicians decouple patient safety reform from work routines to limit these risks.•Expansion of defensive medicine concept from doctor-patient relationships to QI.
Metrics
Details
- Title
- Defensive decoupling: Tensions and contradictions in a US surgical safety intervention
- Creators
- Catherine van de Ruit - Ursinus CollegeMekha Varghese - Drexel University
- Publication Details
- Social science & medicine (1982), v 403, 119421
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001786019200001
- Scopus ID
- 2-s2.0-105040101861
- Other Identifier
- 991022194858304721
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InCites Highlights
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- Web of Science research areas
- Public, Environmental & Occupational Health
- Social Sciences, Biomedical