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Exploring patient safety in Swedish specialised home healthcare: an interview study with multidisciplinary teams and clinical managers
KTH Royal Instute of Technology, Sweden;Ersta Sköndal Bräcke University College, Sweden. (SSiHC)
Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Karolinska Institutet, Sweden. (SSiHC)ORCID iD: 0000-0002-4108-391X
2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, p. 1-7, article id e024068Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Home 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.

DESIGN: An explorative qualitative study.

SETTING: Multidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden.

METHODS: Nine 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.

RESULTS: Patient 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.

CONCLUSION: Patient 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.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018. Vol. 8, no 12, p. 1-7, article id e024068
Keywords [en]
Home healthcare, Patient safety, System approach
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-79258DOI: 10.1136/bmjopen-2018-024068PubMedID: 30552273Scopus ID: 2-s2.0-85058839478OAI: oai:DiVA.org:lnu-79258DiVA, id: diva2:1316525
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, No 2013-2200; 2014-4948)Available from: 2019-05-19 Created: 2019-05-19 Last updated: 2019-08-29Bibliographically approved

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