Background In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients’ homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. Methods The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King’s outline of template analysis. Results We identified three co-existing work processes that contributed to patient safety: “Aligning people and technologies”; “Being alert and staying calm”; and “Coordinating activities based on people and technology”. Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies. Conclusions We conclude that the three work processes identified are essential if the safety alarm is to function for the end user’s safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient’s home, and in doing so, they utilise a repertoire of skills and knowledge.
SAMMENDRAG Etablering av tjenestestandarder har til hensikt å regulere, endre og forbedre fagutøveres arbeid, noe som skal føre til at tjenestene får jevnere og bedre kvalitet. Standarder i den norske helse-og omsorgssektoren er også tenkt å bidra til mer samstemte krav og forventninger til tjenestene. Hensikten med denne studien er å undersøke hvordan sykehjem i norge arbeider med «kvalitet» og om og i så fall hvordan dette påvirker praksiser på tvers av kommuner, sykehjem og avdelinger.Datainnsamlingen er gjennomført i 2016 ved bruk av et spørreskjema, individuelle intervju og fokusgruppeintervjuer samt observasjoner i fem norske sykehjem.Vi har funnet stor variasjon i praksis og rutiner knyttet til «kvalitetsarbeid», til tross for gjentatte innsatser fra myndighetene i å standardisere praksis i tjenestene. Resultatene viser variasjoner både på tvers av og innen sykehjemmene. disse variasjonene viser til det vi oppfatter som et komplisert og varig spenningsforhold mellom standardisering, lokal autonomi og kultur og lokalt innovasjonsarbeid. Vi argumenterer for at standardisering av «beste praksis» er vanskelig forenelig med flere forhold, blant annet med; a) myndighetenes ønske om stadig innovasjon i tjenestene, samt at tjenestene skal vaere individuelt tilpasset, og b) kommunenes grunnleggende autonomi, lokal arbeidskultur ved sykehjemmene knyttet til denne autonomien og lokale prioriteringer.ABSTRACT Service standards involve, amongst other things, an institutional aim of regulation, often through descriptions of «best practice». The aim of the introduction of service standards is to improve the overall quality of the services. The use of standards in the Norwegian healthcare sector, the empirical theme of this article, is, ultimately, a means to equate or level the expectations of the various services. The aim of this study is to explore how Norwegian nursing homes work with «quality» and if, or in what ways, this work has led to more unified practices within and across nursing homes.This study draws on empirical material from 2016, collected through a quantitative survey, and qualitative interviews and observations from five nursing homes in Norwegian municipalities.We found significant variation in practice and routines despite repeated efforts by the authorities to standardize practices in the services. The results show that most variables vary considerably across and within the included nursing homes. The described variation is discussed in relation to what is understood as a complex and perpetual tension between standardization, local/municipal autonomy, «workplace cultures» and the growing demand for innovative services. We argue that standardization of 'best practice' can be difficult to reconcile with (a) the desire for innovative and individually adjusted services, and (b) the fundamental municipal autonomy prevalent in Norway, and the local «workplace cultures» this autonomy is connected to.
Background In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Welfare technology is one of the fastest-growing technology-domains in western health care systems. In the marketing of welfare technology, the expectation is that safety is provided simply by being present in patients’ homes. Whilst both research and health authorities are concerned with developing cost-benefit analysis and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies deliver patient safety. This paper aims to describe how patient safety in home care is performed through and with welfare technology. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work. MethodsWe draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. Building on a qualitative explorative design, we analyse observations of practice and interviews with the actors involved, in accordance with King's outline of template analysis.ResultsOur analysis illuminated three co-existing work processes where patient safety is secured: “Aligning people and technologies”; “Being alert and staying calm”; and “Coordinating activities depending on people and technology”. Attention to these work processes exposes the detailed practices of safety, and how it is produced in relational practices involving multiple people and technologies.ConclusionsWe conclude that the three work processes identified are essential if the safety alarm is to function for the end-user’s safety. Home-dwelling patients' safety is reliant on the people involved with technologies, and technologies do not create this on their own. The efforts of care workers are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.
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