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

• Published in: BMJ open 2018, Vol.8 (12), p.e024068-e024068
• Main Authors: Lindblad, Marléne, Flink, Maria, Ekstedt, Mirjam
• Format: Article
• Language: English
• Subjects: Case Managers - standards; Clinical outcomes; Content analysis; Health care; Home Care Services - organization & administration; Home Care Services - standards; Home healthcare; Hospitals; Humans; Ideology; Interdisciplinary Communication; Interviews; Interviews as Topic; Line managers; Medicin och hälsovetenskap; Men; Nurses; Nursing; Older people; Omvårdnad; Organizational Culture; Organizational Objectives; Patient Care Team - standards; Patient Participation; Patient Preference; Patient Safety; Physicians; Qualitative Research; Safety research; Sweden; System approach; Systematic review; Teams; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-024068

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.