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Towards safer care in Sweden?: Studies of influences on patient safety
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patient safety has progressed in 15 years from being a relatively insignificant issue to a position high on the agenda for health care providers, managers and policymakers as well as the general public. Sweden has seen increased national, regional and local patient safety efforts since 2011 when a new patient safety law was introduced and a four-year financial incentive plan was launched to encourage county councils to carry out specified measures and meet certain patient safety related criteria. However, little is known about what structures and processes contribute to improved patient safety outcomes and how the context influences the results.

The overall aim of this thesis was to generate knowledge for improved understanding and explanation of influences on patient safety in the county councils in Sweden. To address this issue, five studies were con-ducted: interviews with nurses and infection control practitioners, surveys to patient safety officers and a document analysis of patient safety reports. Patient safety officers are healthcare professionals who hold key positions in their county council’s patient safety work. The findings from the studies were structured through a framework based on Donabedian’s triad (with a contextual element added) and applying a learning perspective, highlight areas that are potentially important to improve the patient safety in Swe-dish county councils.

Study I showed that the conditions for the county councils’ patient safety work could be improved. Conducting root-cause analysis and attaining an organizational culture that encourages reporting and avoids blame were perceived to be of importance for improving patient safety. Study II showed that nurses perceived facilitators and barriers for improved pa-tient safety at several system levels. Study III revealed many different types of obstacles to effective surveillance of health care-associated infec-tions (HAIs), the majority belonging to the early stages of the surveillance process. Many of the obstacles described by the infection control practi-tioners restricted the use of results in efforts to reduce HAIs. Study IV of the Patient Safety Reports identified 14 different structure elements of patient safety work, 31 process elements and 23 outcome elements. These reports were perceived by patient safety officers to be useful for providing a structure for patient safety work in the county councils, for enhancing the focus on patient safety issues and for learning from the patient safety work that is undertaken. In Study V the patient safety officers rated efforts to reduce the use of antibiotics and improved communication be-tween health care practitioners and patients as most important for attaining current and future levels of patient safety in their county council. The patient safety officers also perceived that the most successful county councils regarding patient safety have good leadership support, a long-term commitment and a functional work organisation for patient safety work.

Taken together, the five studies of this thesis demonstrate that patient safety is a multifaceted problem that requires multifaceted solutions. The findings point to an insufficient transition of assembled data and information into action and learning for improved patient safety.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1503
Keyword [en]
Patient safety, interventions, perceptions, learning from errors, patient safety reports, learning organization
Keyword [sv]
patientsäkerhet, patientsäkerhetsberättelse, nationella initiativ, lärande organisation, uppfattningar
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-127307DOI: 10.3384/diss.diva-127307ISBN: 978-91-7685-857-8 (print)OAI: oai:DiVA.org:liu-127307DiVA: diva2:921217
Public defence
2016-04-22, Belladonna, Hus 511-001, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-27 Created: 2016-04-19 Last updated: 2016-04-27Bibliographically approved
List of papers
1. Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils
Open this publication in new window or tab >>Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils
Show others...
2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed) Published
Abstract [en]

Background

National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

Methods

The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

Results

The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

Conclusion

Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Patient safety, Patient involvement, Communication, Safety culture, Root cause analysis, Risk analysis, Incident reporting
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90200 (URN)10.1186/1472-6963-13-52 (DOI)000315330200001 ()
Note

Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR)||

Available from: 2013-03-28 Created: 2013-03-21 Last updated: 2017-12-06Bibliographically approved
2. Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions
Open this publication in new window or tab >>Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions
2014 (English)In: BMC nursing, ISSN 1472-6955, Vol. 13, no 23Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. This interview study aimed to explore perceived facilitators and barriers influencing patient safety among nurses involved in the direct provision of care. Considering the importance of nurses with regard to patient safety, this knowledge could facilitate the development and implementation of better solutions.

METHODS: A qualitative study with semi-structured individual interviews was carried out. The study population consisted of 12 registered nurses at general hospitals in Sweden. Data were analyzed using qualitative content analysis.

RESULTS: The nurses identified 22 factors that influenced patient safety within seven categories: 'patient factors', 'individual staff factors', 'team factors', 'task and technology factors', 'work environment factors', 'organizational and management factors', and 'institutional context factors'. Twelve of the 22 factors functioned as both facilitators and barriers, six factors were perceived only as barriers, and four only as facilitators. There were no specific patterns showing that barriers or facilitators were more common in any category.

CONCLUSION: A broad range of factors are important for patient safety according to registered nurses working in general hospitals in Sweden. The nurses identified facilitators and barriers to improved patient safety at multiple system levels, indicating that complex multifaceted initiatives are required to address patient safety issues. This study encourages further research to achieve a more explicit understanding of the problems and solutions to patient safety.

Keyword
Implementation; Intervention; Interview; Multifaceted; Nurse; Patient safety; Qualitative content analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-115558 (URN)10.1186/1472-6955-13-23 (DOI)25132805 (PubMedID)2-s2.0-84908085240 (Scopus ID)
Available from: 2015-03-16 Created: 2015-03-16 Last updated: 2016-04-27
3. Using surveillance data to reduce healthcare–associated infection: a qualitative study in Sweden
Open this publication in new window or tab >>Using surveillance data to reduce healthcare–associated infection: a qualitative study in Sweden
2015 (English)In: Journal of Infection Prevention, ISSN 1757-1774, Vol. 16, no 5, 208-214 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Healthcare-associated infection (HAI) surveillance data can be used to estimate the scope, spread and location of infections, monitor trends, evaluate preventive efforts, and improve practices, policy and facility planning. In Sweden, national point prevalence surveys (PPS) have been conducted twice yearly in all county councils since 2008.

Aim: The aim of this study was to identify key obstacles concerning the HAI surveillance process.

Methods: Twenty-two infection control practitioners (ICPs) from all county councils in Sweden were interviewed, using semi-structured interview guides. Data were analysed using qualitative content analysis.

Results: Sixteen types of obstacles pertaining to four surveillance stages were identified. Most obstacles were associated with the first two stages, which meant that the latter stages of this process, i.e. the use of the results to reduce HAI, were underdeveloped. The ICPs observed scepticism towards both the PPS methodology itself and the quality of the HAI data collected in the PPS, which hinders HAI surveillance realising its full potential in Swedish healthcare.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keyword
Healthcare-associated infection, surveillance data, prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-120835 (URN)10.1177/1757177415588380 (DOI)
Available from: 2015-08-26 Created: 2015-08-26 Last updated: 2016-04-27
4. Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.
Open this publication in new window or tab >>Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 98, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.

Methods

The study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.

Results

A total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.

Conclusion

Patient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils’ patient safety work, the PSRs are perceived as useful at various system levels.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keyword
Healthcare, Patient safety, Patient safety reports
National Category
Social and Clinical Pharmacy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-127298 (URN)10.1186/s12913-016-1350-5 (DOI)000372864800001 ()27001079 (PubMedID)
Note

Funding agencies:  Swedish National Board of Health and Welfare

Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-11-30Bibliographically approved

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