A problem shared...? Teamwork, autonomy and error in assisted conception.

This paper explores the benefits and drawbacks of new team-based approaches to error management in medicine through a case study of teamwork, double witnessing and incident reporting in assisted conception clinics in the UK. This is based upon the analysis of a series of semi-structured interviews with people working in assisted conception clinics and two periods of ethnography in clinics, conducted between 2004 and 2007, as part of an ESRC-funded study on the ethics of assisted conception and embryo research. In common with other studies of practitioners' management of error, I identify a series of tensions around individual and collective autonomy in identifying and preventing error, for the assisted conception team as a whole, and for particular groups within it, notably consultants and embryologists. I found that team-based approaches could create the conditions for error to occur when it undermined independent thinking, responsibility or concentration. There was also a danger that teamwork could come to be associated with particular 'technical' practices or occupational groups, diminishing its relevance and value in clinical settings. I, therefore, conclude that team-based approaches and professional autonomy have their 'dark' as well as their 'light' sides (Vaughan, D. (1999). The dark side of organisations: mistake, misconduct, and disaster. Annual Review of Sociology, 25, 271-305). Errors cannot be prevented in their entirety, but they can be well managed when teamwork and autonomy are complementary. Drawing on Reason (Reason, J. (2004). Beyond the organisational accident: the need for "error wisdom" on the frontline. Quality Safety in Health Care, 12, ii28-ii33), I argue that informed vigilance and intelligent wariness in a necessary compliment to systems-based approaches to error management in assisted conception in particular, and medicine in general.