How healthcare professionals in acute care environments describe patient safety: A case study

Patient safety has become an international healthcare priority over the past two decades. The prevailing approach to prevent harm in healthcare environments is the implementation of systems and structures that have made significant safety gains in high reliability organisations, such as aviation and nuclear power. However, similar safety improvements have not been realised in the healthcare environment. Studies suggest occupational culture is of importance, though our understanding of the relevance of safety subcultures is limited. This study explores how patient safety is described from the perspective of clinicians and organisational managers in an acute care hospital, using embedded case study design.  The case for this study was a New Zealand tertiary hospital. The emergency department and intensive care unit provided the settings for the embedded units. Three interviews with health care managers and six focus groups with nineteen doctors and nineteen nurses were undertaken. An interview guide, informed by the literature was used in data collection. Thematic data analysis was conducted within and across the case and embedded units. The theoretical concept of safety capability was developed from the data. Safety capability was defined as the ability to provide safe patient care and underpinned by the themes of resilient culture, and anticipation and vigilance.  A key finding of this research was that acute care environments have unique patient safety challenges, and these are influenced by complex factors. Patient safety was not assessed as being safe or unsafe, but rather perceived to exist across different levels of safety. Given this, healthcare professionals accept that some harm is inevitable in the healthcare setting. Doctors, nurses and managers understand and manage patient safety differently, and this affects how patient safety is addressed. This study identified anticipatory and vigilant systems are used to proactively manage risk by doctors and nurses, whereas incident reporting systems are used more by managers.    Given the need to keep patients safe and avoid harm, more proactive patient safety systems are needed to manage patient safety in hospitals; this will require a paradigm shift away from current reactive safety systems. Proactive systems must be underpinned by a resilient patient safety culture that focuses on the right building blocks to produce balance of resources and targets and develop collaboration in organisations. This will bring about flexibility and stability to meet the complex conditions presented by acute care environments.