Epistemic Injustice in Incident Investigations: A Qualitative Study

Abstract

Serious incident investigations-often conducted by means of Root Cause Analysis methodologies-are increasingly seen as platforms to learn from multiple perspectives and experiences: professionals, patients and their families alike. Underlying this principle of inclusiveness is the idea that healthcare staff and service users hold unique and valuable knowledge that can inform learning, as well as the notion that learning is a social process that involves people actively reflecting on shared knowledge. Despite initiatives to facilitate inclusiveness, research shows that embracing and learning from diverse perspectives is difficult. Using the concept of 'epistemic injustice', pointing at practices of someone's knowledge being unjustly disqualified or devalued, we analyze the way incident investigations are organized and executed with the aim to understand why it is difficult to embrace and learn from the multiple perspectives voiced in incident investigations. We draw from 73 semi-structured interviews with healthcare leaders, managers, healthcare professionals, incident investigators and inspectors, document analyses and ethnographic observations. Our analysis identified several structures in the incident investigation process, that can promote or hinder an actor's epistemic contribution in the process of incident investigations. Rather than repeat calls to 'involve more' and 'listen better', we encourage policy makers to be mindful of and address the structures that can cause epistemic injustice. This can improve the outcome of incident investigations and can help to do justice to the lived experiences of the involved actors in the aftermath of a serious incident.

Keywords: Epistemic injustice; Incident investigations/Root Cause Analysis; Incident reporting systems; Patient and family involvement; Professional involvement.

Fig. 1

Overview of serious incident investigation practices in Dutch healthcare organizations *Although these stages are—strictly speaking—not part of the actual investigation process, they must be described in the final report. The HYCI monitors these steps. As a result, ‘staff support’ and ‘initial disclosure’ practices have become an integral part of serious incident investigation protocols in most Dutch healthcare organizations