Exploring patient safety in Swedish specialised home healthcare: an interview study with multidisciplinary teams and clinical managers

Abstract

ObjectiveHome healthcare is the fastest growing arena in the healthcare system but patient safety research in this context is limited. The aim was to explore how patient safety in Swedish specialised home healthcare is described and adressed from multidisciplinary teams’ and clinical managers’ perspectives.DesignAn explorative qualitative study.SettingMultidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden.MethodsNine focus group interviews with multidisciplinary teams and six individual interviews with clinical managers were conducted, in total 51 participants. The data were transcribed verbatim and analysed using qualitative content analysis.ResultsPatient safety was inherent in the well-established care ideology which shaped a common mindset between members in the multidisciplinary teams and clinical managers. This patient safety culture was challenged by the emerging complexity in which priority had to be given to standardised guidelines, quality assessments and management of information in maladapted communication systems and demands for required competence and skills. The multiple guidelines and quality assessments that aimed to promote patient safety from a macro-perspective, constrained the freedom, on a meso-level and micro-level, to adapt to challenges based on the care ideology.ConclusionPatient safety in home healthcare is dependent on adaptability at the management level; the team members’ ability to adapt to the varying conditions and on patients being capable of adjusting their homes and behaviours to reduce safety risks. A strong culture related to a patient’s value as a person where patients’ and families’ active participation and preferences guide the decisions, could be both a facilitator and a barrier to patient safety, depending on which value is given highest priority.

Exploring challenges in quality and safety work in nursing homes and home care – a case study as basis for theory development

“…Management, culture and systems for better quality and safety have been the main topics in Norwegian national healthcare policy [1][2][3]. These key challenges have also been highlighted internationally [4][5][6][7]. There is a clear need to ensure leadership, a culture of openness and learning, and a system for developing, embedding and sustaining quality and safety improvements.…”

“…There is a clear need to ensure leadership, a culture of openness and learning, and a system for developing, embedding and sustaining quality and safety improvements. The delivery of healthcare is becoming more complex as a result of demography, patient preferences and limited resources [4,6]. A pressure for immediate change may create a cultural bias to jump to implementation without a thorough planning of interventions [4,6].…”

“…The delivery of healthcare is becoming more complex as a result of demography, patient preferences and limited resources [4,6]. A pressure for immediate change may create a cultural bias to jump to implementation without a thorough planning of interventions [4,6]. These factors can undermine performance and explain some variations in quality and safety [4,8].…”

“…Norwegian research by Glette et al [10] shows that managers and employees experience patients as sicker and more complex in nursing homes and that patient care is also becoming more time-consuming. Specific challenges in home care are the unregulated environment, fragmentation of care, discontinuity and multiple care givers that lack overview of patient status [6,11]. There are fewer quality indicators in both homecare and nursing home settings in Norway, compared to specialized healthcare services (e.g.…”

Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

“…Evidence from past research, mainly deriving from in-hospital settings, are not easily transferred to home healthcare settings, as the preconditions for safety in the context of home healthcare, in essential aspects are fundamentally different from inhospital care [2,3]. Safety in home healthcare is challenged by unclear boundaries of responsibilities and communication paths between different care providers, patients, and family caregivers [4,5].…”