Exploration of Patient Safety Phenomena in Rehabilitation and Complex Continuing Care

Abstract

Patient safety has been relatively unexplored in rehabilitation and complex continuing care (CCC) settings. From the perspectives of staff members, this qualitative study aimed to explore patient safety phenomena that exist within rehabilitation/CCC and to identify the characteristics of the current workplace culture that act as enablers of or barriers to patient safety. Sixty-six staff members in a large, multisite, academic rehabilitation/CCC health centre volunteered to participate in one of six interprofessional focus groups, designed to model patient care teams that exist within the clinical programs; one focus group was also conducted with support services staff. Thematic analysis revealed that rehabilitation/CCC settings present with distinct patient safety issues due to the unique and increasingly complex populations that are served, and the place of rehabilitation/CCC along the continuum of care. Enablers and barriers identified related to teamwork, culture, resources and organizational and individual responsibility. Results of this study have helped form the foundation for future patient safety initiatives within our settings, with clear emphasis on enhancing an open and just culture in which to discuss safety issues through development of improved leadership-staff relations, teamwork and communication and clearer processes and structures for accountability. The approach to addressing these issues must fit within our rehabilitation models of care.

Cardiac rehabilitation and the therapeutic environment: the importance of physical, social, and symbolic safety for programme participation among women

“…Although our data were collected in 2005–2006, we posit that our findings remain relevant. Despite a call by Fancott et al. (2006) and Tardif et al.…”

“…Our safety framework builds on the work of Fancott et al (2006) who explored 'patient safety phenomena ... and characteristics of the current workplace culture that act as enablers of or barriers to patient safety' (p. 135) through the lens of HCPs. The rehabilitation staff in Fancott's et al's study (2006) provided a robust interpretation of safety:…”

“…Although our data were collected in 2005-2006, we posit that our findings remain relevant. Despite a call by Fancott et al (2006) and Tardif et al (2008) for a more comprehensive inquiry into the multidimensionality of safety, no one has, to date, put forth a comprehensive safety framework. We suggest that our research findings answer this call in a cardiac prevention and rehabilitation context.…”

“…2007). Although researchers engaged in patient safety research in rehabilitation hospitals advocate for an understanding of patient safety that extends beyond the purely physical dimensions of the concept (Fancott et al. 2006, Tardif et al.…”

“…Women's programme engagement is also influenced by the perceived safety of the neighbourhood where community-based PP and hospital-based CR programmes are situated, as well as access to safe transportation (Clark et al 2004, Dawson et al 2007. Although researchers engaged in patient safety research in rehabilitation hospitals advocate for an understanding of patient safety that extends beyond the purely physical dimensions of the concept (Fancott et al 2006, Tardif et al 2008, to the best of our knowledge, comprehensive inquiries into the multi-dimensionality of safety specifically in PP and CR programmes do not exist. Moreover, the intersection of safety and place (or therapeutic landscape) has also been under-explored in this literature.…”