Lindblad Marléne, Flink Maria, Ekstedt Mirjam
School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Royal Institute of Technology, Stockholm, Sweden.
Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
BMJ Open. 2018 Dec 14;8(12):e024068. doi: 10.1136/bmjopen-2018-024068.
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.
An explorative qualitative study.
Multidisciplinary teams and clinical managers were recruited from three specialised home healthcare organisations in Sweden.
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.
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.
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.
家庭医疗保健是医疗系统中发展最快的领域，但在此背景下的患者安全研究有限。本研究旨在从多学科团队和临床管理人员的角度，探讨瑞典专业家庭医疗保健中的患者安全是如何被描述和处理的。
一项探索性定性研究。
从瑞典三个专业家庭医疗保健组织中招募多学科团队和临床管理人员。
对多学科团队进行了9次焦点小组访谈，对临床管理人员进行了6次个人访谈，共有51名参与者。数据逐字转录，并采用定性内容分析法进行分析。
患者安全是既定护理理念中固有的，这种理念塑造了多学科团队成员和临床管理人员之间的共同思维模式。这种患者安全文化受到新出现的复杂性的挑战，在这种复杂性中，必须优先考虑标准化指南、质量评估以及在不适应的通信系统中管理信息，以及对所需能力和技能的要求。旨在从宏观角度促进患者安全的多项指南和质量评估，在中观和微观层面限制了基于护理理念适应挑战的自由度。
家庭医疗保健中的患者安全取决于管理层面的适应性；团队成员适应不同情况的能力，以及患者调整其家庭和行为以降低安全风险的能力。一种与患者个人价值相关的强烈文化，即患者及其家人的积极参与和偏好指导决策，根据给予最高优先级的价值不同，可能既是患者安全的促进因素，也是障碍。
