Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work

Abstract

Background Safety culture can be described and understood through its manifestations in the organization as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers’ is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units. Methods Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. Results We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. Conclusions Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit’s safety culture.

Workplace violence from the perspective of hospital ward managers in Sweden: A qualitative study

“…Although other studies have described ward managers as excluded from important decision making and lacking support (Ericsson & Augustinsson, 2015; Hedsköld et al, 2021), ward managers in the current study appeared independent and relatively unconcerned about support provided from the hospital organization. When needed, security guards could be called in and occupational services could support victimized professionals.…”

“…This might be yet another example of the distance between ward management and the senior hospital management as seen in previous research (Ericsson & Augustinsson, 2015;Heckemann et al, 2017Heckemann et al, , 2019Hedsköld et al, 2021;Morphet et al, 2019). Importantly, there were occasions when the voice of the hospital organization strengthened the authority of the ward manager, for instance when printed 'house rules' were used in a confrontation with threatening or violent patients or visitors.…”

“…Even though ward managers are part of the management system, they have described themselves as excluded from important decision making and without support from higher management (Ericsson & Augustinsson, 2015; Hedsköld et al, 2021). It has also been explained that available policies and guidance are difficult to apply in various situations and contexts (Morphet et al, 2019).…”

Patient safety culture and associated factors in secondary health care of the Capital Region of Denmark: influence of specialty, healthcare profession and gender

“…An interview study with first-line managers shows how they perceive their central role. None of them, however, mentions the possibility of an evaluation of PSC 29. A safe learning environment and a positive learning culture are closely linked to PSC.…”

“…None of them, however, mentions the possibility of an evaluation of PSC. 29 A safe learning environment and a positive learning culture are closely linked to PSC. Hence, leaders should support a learning culture and create an environment where HCPs feel comfortable and have opportunities to raise concerns, ask questions and learn from adverse events.…”