Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework

Abstract

Background Understanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes but little attention has been paid to safety culture in this sector. In this study we aimed to adapt the Manchester Patient Safety Framework (MaPSaF), a commonly used tool in the health sector, for use in care homes and then to test its face validity and preliminary feasibility as a tool for developing a better understanding of safety culture in the sector.Methods As part of a wider improvement programme to reduce the prevalence of falls, pressure ulcers and urinary tract infections amongst residents in 90 care homes in England, we carried out a multi-method participatory evaluation of the adaptation of MaPSaF and its face validity and feasibility for care home staff. Data were collected using participant observation, interviews, documentary anlaysis and a survey, and were analysed thematically.Results MapSaf required considerable adaptation in terms of its length, language and content in order for it to be perceived to be acceptable and useful to care home staff. The changes reflected differences between the health and care home sectors in terms of the local context and wider policy environment, and the expectations, capacity and capabilities of the staff.Conclusions A new tool, named 'Culture is Key' was developed and has the potential to be used more widely in care homes to address deficiencies in resident care by deepening staff understanding of the safety culture of their organisations. words

Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes

“…Most studies ( n = 35) reported single arm intervention studies with comparison of quantitative data captured about clinical outcomes before and after the quality improvement project was carried out [ 23 – 57 ]. Qualitative studies were the second largest group ( n = 19) [ 12 , 23 , 27 , 30 , 58 – 72 ], including the following methods: participatory action research ( n = 2) [ 12 , 63 ], observational ( n = 4) [ 62 , 73 – 75 ], interviews ( n = 1) [ 64 ], questionnaire ( n = 1) [ 69 ]. Eleven studies were interventional studies with a comparator arm, with quantitative outcome measures, including; 8 randomised controlled trials, all of which were cluster randomised at care home level [ 76 – 83 ].…”

“…These were not duplicate publications, but rather publications of complementary descriptions and analyses of, often complex, QI projects. The six studies were SCOPE (Safer care for older persons (in residential) environments) [ 23 , 65 , 90 ], Connect for quality [ 77 , 91 ], INTERACT (Interventions to Reduce Acute Care Transfers) [ 59 , 79 , 92 , 93 ], PROSPER (PROmoting Safer Provision of care for Elderly Residents) [ 12 , 15 , 72 ].…”

“…The review team did, however, identify weaknesses in study design and reporting. We found 35 studies either had deficiencies in methods [ 24 , 30 , 33 , 37 , 39 , 50 – 55 , 57 , 69 , 70 , 73 – 75 , 82 – 84 ] or were descriptive without process or outcome data [ 12 , 15 , 43 – 50 , 61 , 62 , 66 , 67 , 71 , 72 , 76 , 88 , 89 ]. Weaknesses included small sample size (for example, one care home sampled), no comparator or baseline, and number of participants not reported.…”

An evaluation of a safety improvement intervention in care homes in England: a participatory qualitative study

“…Third, the prevailing safety culture of the homes was assessed using a version of the Manchester Patient Safety Framework (MaPSaF) 22 adapted for use in care homes. 23 The three main components of the intervention were delivered or facilitated over a six-month period in each care home by members of the local government improvement team in partnership with NHS staff and the evaluation team. A strong emphasis was placed on providing support and advice, and sharing learning between the participating homes.…”

Patient safety culture in home care service

“…An assessment of patient safety culture is the first step towards its implementation (7) in order to improve care (6) and to support service management through its monitoring, thus influencing organizational changes (3) . Such assessment initially only occurred in the hospital environment (1,(8)(9) , but in recent years its use has been increasing in long-term care facilities (8,10) , elderly homes (9) , and primary attention (1) , as it is understood that risks are present in all healthcare spheres (11) .…”