Le, Thoai Nguyen Anh
(2025)
Patient safety culture in homecare in England: an exploratory study.
PhD thesis, University of Nottingham.
Abstract
Background: In the health and social care sector, patient safety culture is a key priority. However, research on patient safety culture has extensively focused on hospitals, with very few studies examining safety culture in homecare. Homecare is a crucial part of the health and social care system in England, and there has also been an increase in demand for homecare services due to the aging population and the impact of the COVID-19 pandemic. Consequently, the UK government has made significant efforts and strategic commitments to reform adult social care and highlight the importance of research in homecare.
Aims: This PhD thesis aims to explore the patient safety culture in homecare in England. The research seeks to identify the foundational factors that constitute high-quality and safe homecare, examine the prevalent safety issues in the sector, and address the fundamental challenges in delivering such care services. Additionally, the study aims to understand approaches to safety and investigate the role of HRM practices in shaping and strengthening homecare safety culture.
Methodology: This study adopts an interpretivist epistemology to explore the rich meanings of safety culture in homecare. Using an inductive approach, this study collects qualitative data to develop theoretical concepts from detailed interpretations of social actors. The research strategy employs narrative inquiry and triangulation, incorporating semi-structured interviews and documents for data collection. Thematic analysis is used for interview data, while qualitative content analysis is applied to written documents.
Findings: The study reveals a number of significant findings. First, safe homecare consists of several foundational factors of high-quality care, person-centred care, and the engagement of family members and informal support networks (e.g., friends, neighbours). Second, safety incidents are categorised into four types: medication safety, physical and health safety, emotional and social safety, and functional safety. Third, fundamental challenges that serve as barriers to high-quality care and act as risk factors leading to safety issues relate to the institutional context, organisational management, work environment, teams, individual staff, tasks, service users, and informal support networks. Fourth, initiatives and practices that have been made to improve care quality and safety culture include collaborations and partnerships, inclusive and personalised care service, strong leadership and staff support, digital technology integration, and effective HRM practices.
Discussions: The insightful findings help answer the research questions, achieve the primary research aim, and develop theoretical frameworks. First, the interconnected fundamental challenges framework depicts how homecare challenges are interconnected and function as barriers to high-quality care and risk factors for safety incidents. This is useful for identifying safety issues, understanding their origins, and proposing measures to minimise errors and risks, which is in line with the Safety-1 approach. Second, the homecare safety framework, which incorporates both Safety-1 and Safety-2 approaches, illustrates the link between best practices, fundamental challenges, and safety incidents. These frameworks offer a detailed, sector-specific approach to high-quality and safe care and present tailored insights for developing a robust safety culture in homecare organisations.
Contributions: This research contributes to the literature by offering sector-specific insights into homecare safety culture. The study also contributes to the literature on the link between effective HRM practices and organisational positive outcomes, especially in the context of homecare providers in England and during the COVID-19 pandemic. Furthermore, the frameworks developed in this research make a theoretical contribution to the field of safety approach and management in healthcare.
Implications: This research provides practical implications for stakeholders in homecare, emphasising continuous staff development, genuine care, clear communication, patient-centred approaches, and family engagement. It highlights the need for collaboration, personalised care, strong leadership, digital integration, and effective HRM practices to enhance safety culture and care quality, with frameworks providing sector-specific guidelines for risk mitigation and continuous improvement.
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