Résumé

The quest to improve the quality and safety of care is a major preoccupation in healthcare organisations. The quality and safety of care depend mainly on the practices of medical and nursing staff. The article investigates clinical quality and safety from the perspective of the 'high reliability organisation' (HRO). An exploratory qualitative approach is adopted in order to analyse the mechanisms of collective action using an interpretative framework based on the HRO characteristics. 13 interviews were conducted with medical and nursing staff and managers in 2 acute care departments in a teaching hospital: a paediatric critical care department and a paediatric haematology-oncology department. The conditions of patients in these departments are complex and constantly changing, which increases the risk of mistakes. The results show that, above and beyond the clinical standards and protocols laid down by the French National Authority for health and the medical and nursing associations, the quality and safety of care depend on a collective mind and collective action, which are shown to rely, in turn, on shared knowledge and representations. These are constructed in the course of different management situations (training, mentoring, meetings, clinical simulations, etc.) as well as through informal exchanges between different categories of personnel. While they are essential, these management situations are none the less fragile and it is the responsibility of managers and supervisors to ensure that they are maintained.

Keywords: high reliability organisations, hospital, Medical and nursing staff, organisational reliability, Quality and safety of care.