Abstract
The problem of high internal temperatures in United Kingdom (UK) National Health Service (NHS) hospitals and its impacts on health service delivery is underexplored. Application of the Morgan et al. (2002) mental models approach to risk communication, to the hazard of indoor overheating in hospitals had yet to be investigated. Furthermore, application of the Reason (2000) Swiss cheese model to the problem had remained unexplored. This research sought to address this gap. The three research objectives are: to use a modification of the Morgan et al. (2002) mental models approach to develop an expert and a recipient model of the hazard; to explore their development through the lens of the Reason (2000) Swiss cheese model; and to investigate the Swiss cheese model in this research context.This qualitative study uses in-depth, semi-structured interviews with four NHS Trust experts (risk communicators) and twenty one risk communication recipient participants from a ‘key knowledgeable’ purposeful sample, to generate data. The data analysis is based on thematic analysis.
The UK NHS Trust’s expert and recipient models created, provide new insights into indoor overheating coexisting with the unexpected COVID 19 event, uniquely through the Swiss cheese theory. The researcher establishes that reduced environmental sustainability performance, financial and reputational damage, as well as hospital visitor harm and discomfort are pathways of risk to health services that result from indoor overheating. Thus, extending the existing limited literature on heatwaves and overheating events on health service delivery. The study establishes that the expert and recipient models align with the Reason (2000) Swiss cheese model theory, extending the Swiss cheese model literature. The study identifies a limitation of the Swiss cheese model and proposes a new model of an unforeseen hazard event concurrent with an expected hazard to overcome the limitation. The identification of the limitation and the researcher’s proposed model offer new insights into Reason’s (2000) Swiss cheese model and hold importance for the advancement of all hazards’ future risk communication.
The disparities between the expert and recipient models of indoor overheating are established, as well as an inconsistency between all-year-round indoor overheating and the timing of the UK Health Security and Met Office adverse weather alerts. These valuable recipients’ insights are now available to the NHS Trust’s experts. A key focus for risk communication efforts and the development of more credible information messages about the risk in practice. The thesis makes recommendations for practice and policy to the host NHS Trust and more widely.
| Date of Award | 18 Mar 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Sara Hadleigh-Dunn (Supervisor) & Liza Howe-Walsh (Supervisor) |