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چکیده : 

This article explores and explains escalating contradictions between two modes of clinical

risk management which resisted hybridisation. Drawing on a Foucauldian perspective,

these two modes – ethics-orientated and rules-based – are firstly characterised in an original

heuristic we develop to analyse clinical risk management systems. Some recent sociologically

orientated accounting literature is introduced, exploring interactions between

accountability and risk management regimes in corporate and organisational settings;

much of this literature suggests these systems are complementary or may easily form

hybrids. This theoretical literature is then moved into the related domain of clinical risk

management systems, which has been under-explored from this analytic perspective.

We note the rise of rules-based clinical risk management in UK mental health services

as a distinct logic from ethics-orientated clinical self-regulation. Longitudinal case study

data is presented, showing contradiction and escalating contest between ethics-orientated

and rules-based systems in a high-commitment mental health setting, triggering a crisis

and organisational closure. We explore theoretically why perverse contradictions emerged,

rather than complementarity and hybridisation suggested by existing literature. Interactions

between local conditions of strong ideological loading, high emotional and personal

involvement, and rising rules-based risk management are seen as producing this contest

and its dynamics of escalating and intractable conflict. The article contributes to the general

literature on interactions between different risk management regimes, and reveals

specific aspects arising in clinically based forms of risk management. It concludes by considering

some strengths and weaknesses of this Foucauldian framing.