Organising experiences through activity: a comparison of aviation and medical professionals’ concept of safety

This thesis examines the concept of safety in two groups of professionals working in the fields of aviation and medicine. These professional activities are uniquely structured but have been compared in the literature as having certain similar characteristics. However, recent attempts at strengthening patient safety by transferring methods from aviation have had only a small effect, with evidence suggesting that professional engagement has been poor. One possibility is that there are large disparities in conceptual understanding about safety across these groups. This was derived from socio-cultural theories of knowledge showing how collective experiences are formed into meaningful categories through situated learning and structured internally through semiotic mediation. A cross cultural comparison of the safety concept was carried out using linguistic data to capture the concept. Forty-one interviews were conducted with participants across two groups comprising senior airline pilots and hospital consultants. Grounded theory analysis was used to code and analyse the da-ta. Taxonomic structures of the two safety concepts, comprising their main semantic sub-categories, are presented, along with models explaining their internal relation-ships. In aviation, a core category of control was identified involving principles of stability, invariance, and causal attribution. This is dominated by the sub-categories of institutional control and personal autonomy, which are mediated by the availability of information and predictability of events. In the medical sample a core category of clinical success was revealed. This encompassed overall quality of outcomes based on Bayesian thinking about different risks along possible treatment paths. The thesis shows how conceptual knowledge is formed through mediational means within the context of specific purposive activities. A tentative theory of conventionalisation is proposed to explain why top-down interventions for transferring practices between cultures fail when differences between key concepts are large. Interventions, such as change laboratories to scaffold learning towards re-conceptualisation are recommended.