Integrating safety concepts in health and social care

Abstract

Purpose Keeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England. Design/methodology/approach This paper presents the authors’ viewpoint based on personal, professional and research experience. Findings In healthcare, safety is usually conceptualised as the management of error, with risk considered on a universal level. In social care, the safeguarding process balances choice and control with individualised approaches to keeping adults safe, but lacks the established reporting pathways to capture safety incidents. Efforts to safely integrate health and social care services are currently constrained by a lack of shared understanding of the concepts of safety and safeguarding without further consideration of how these approaches to keeping people safe can be better aligned. As such, there is a need for a single, unified discourse of patient safety that cuts across the patient safety and safeguarding concepts and their associated frameworks in health and social care settings. Originality/value A single unified concept of safety in health and social care could coincide with an integrated approach to the delivery of health and social care, improving the care of patients transitioning between services.

Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study

“…In England, healthcare policy is placing an increasing emphasis on greater integration between health and social care services [9, 10]. However, there are many challenges associated with delivering safe, integrated care, including a lack of alignment between health and social care organisations in their understanding of, and approaches to, safety [11]. Furthermore, providing safe care during discharge from hospital, which is just one stage of a patient’s transition, is rarely perceived by clinicians to be a linear or causal occurrence.…”

The scope of safety in English older adult care homes: a qualitative analysis of Safeguarding Adult Reviews

“…However, reliability indicators would need to be balanced against other more person-centred measures given that care homes should provide a suitably homely environment and care that improves quality of life. This tension between standardisation and individualisation is found all across social care where safety processes, including safeguarding, must be balanced with service users’ individual choice and control (Scott et al , 2017). Another limitation on a dominant focus on measurement of reliability is that it is likely to lead to a proliferation of standardised protocols and risk assessments as the main mechanism for improving safety.…”

Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

“…Consequently, integrated care between the health and social care sectors is lacking in relation to patient safety, and opportunities for organisational, cross-sector learning are likely being missed. 14 The COVID-19 pandemic, caused by the SARS-CoV-2, has had a significant impact on care homes within England due in part to a poor policy response. 17 The pandemic has also placed a specific focus on the safety and appropriateness of transitions between hospital and care home, with unsafe hospital discharge into care homes being identified as a cause of anxiety among care home staff.…”

“… 9 Common challenges include communication failures, 10 medication errors 11 and incorrect documentation. 12 From an organisational governance perspective, identifying safety incidents that relate to transitions in care is especially difficult; care home and hospital organisations have different priorities, 13 health and social care sectors use different definitions of safety, 14 and efforts to involve patients directly have had mixed results. 15 16 Furthermore, the patient would be outside of the hospital’s responsibility when the incident would be identified, and therefore it would be unlikely that a hospital staff member contacted by a care home would proceed to report a safety incident.…”

“…Consequently, integrated care between the health and social care sectors is lacking in relation to patient safety, and opportunities for organisational, cross-sector learning are likely being missed. 14 …”