Passing laws is not enough to change staff practice: The case of legally mandated “incident” reporting in Sweden

Abstract

Background: It is mandatory for staff in Swedish community services for people with intellectual disabilities to report incidents of error or malpractice. Aim: The aim is to study if incident reports contribute to developing quality in services for people with intellectual disabilities who present with challenging behaviours. Method: 159 reports on incidents from group homes and daily activities services were accessed and analysed using narrative thematic analysis. Results: Most reports concerned altercations between service users. Analysis focused mainly on the immediate incident and attributes of service users. Amendments were not (obviously) aligned with causes, and neither sufficiently addressed structural shortcomings. Restrictive measures were described, but changes in practices were not mentioned. Reports including Selfinjurious behaviour (SIB) were conspicuously absent. Conclusion: Reports are handled in a seemingly perfunctory manner, without any development. Quality development relying on staff reports and front-line managers' investigations requires support based on values rather than on the legal framework.

The Use of Restrictive Measures in Community Services for People With Intellectual Disabilities in Sweden

“…This study is part of a larger project (Björne et al, 2021) examining factors that hinder and facilitate organizational change in support for people with ID whose behavior is described as challenging. This change includes the reduction of restrictive interventions, to enable the intentions of the legislation of supporting a self‐determined life.…”

Exploring mandatory reporting in social care and social services in Sweden

“…The result from the reported incidents in this study points to a less optimistic conclusion: mistreatment in elderly care seems to be reported, investigated and then addressed with a sentence on the need to introduce new routines. Such perfunctory processes may well explain the lack of evidence for recurrent incidents being prevented (Björne et al, 2021; Kjellberg, 2020). Following the overall aim of incident reporting (WHO, 2021), responses must be grounded in a sharper analysis of why an incident occurred, followed by actions to address underlying problems.…”

“…To our knowledge, this is the first time an overview of staff-reported incidents in social services has been conducted to provide an analysis of types of incidents, contributory factors and actions. Previous studies from Sweden have focussed on either elderly care (Kjellberg, 2012;Rytterström et al, 2013) or disability services (Björne et al, 2021), and these studies have not analysed as large a sample as this one: all reports from one large region in Sweden over the course of a year.…”

“…The HSCI will supervise the investigation or return it to the municipal social welfare board if it deems the measures taken to be insufficient or unsatisfactory (Kjellberg, 2020). Research has been critical of the reporting system in Sweden's social services, pointing out that there is no evidence of recurrent incidents being prevented or mistakes being learned from (Björne et al, 2021; Kjellberg, 2020).…”

“…Inadequate handover procedures between different care settings and falls are also common issues in incident reports in elderly care (Hignett et al, 2013; Scott et al, 2019). There is evidence from disability services that the outcomes of mandatory reporting systems are not leading to shortcomings being amended in practice (Björne et al, 2021), and three in five frontline disability workers feel that their employers' safety and incident reporting protocols are inadequate due to their organisations' low prioritisation of safety, minimal support for staff to report and overly complex reporting systems (Cortis & Van Toorn, 2022). Another area of social services is child protection, and regulations on how to report concerns over children differ between countries.…”