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Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
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.

Place, publisher, year, edition, pages
2014. Vol. 13, no 23
Keyword [en]
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: urn:nbn:se:liu:diva-115558DOI: 10.1186/1472-6955-13-23PubMedID: 25132805Scopus ID: 2-s2.0-84908085240OAI: oai:DiVA.org:liu-115558DiVA: diva2:795536
Available from: 2015-03-16 Created: 2015-03-16 Last updated: 2016-04-27
In thesis
1. Towards safer care in Sweden?: Studies of influences on patient safety
Open this publication in new window or tab >>Towards safer care in Sweden?: Studies of influences on patient safety
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
Patient safety, interventions, perceptions, learning from errors, patient safety reports, learning organization, patientsäkerhet, patientsäkerhetsberättelse, nationella initiativ, lärande organisation, uppfattningar
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-127307 (URN)10.3384/diss.diva-127307 (DOI)978-91-7685-857-8 (ISBN)
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

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Nygren, MikaelaRoback, Kerstin

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