Patient safety culture from the perspective of home healthcare providers and family caregivers: a qualitative study.

Abstract

Patient safety culture (PSC) in home healthcare centres (HHCs) remains insufficiently examined compared with hospital settings. HHCs are licensed facilities that coordinate and deliver skilled nursing, rehabilitation and other professional services directly to patients' own homes. The present study investigates the dimensions of PSC in HHCs from the perspectives of both healthcare providers and family caregivers. This study was conducted using a qualitative approach and the conventional content analysis method (Graneheim and Lundman). Participants (n=15) included managers, nurses, physiotherapists, physicians, a nurse assistant and family caregivers recruited by purposive sampling. Data were collected through semi-structured interviews (45-90 min), participant observations (15 hours total) and field notes. Data collection continued until saturation was achieved. We extracted 1103 initial codes and grouped them into 32 primary subcategories, 15 subcategories and three main categories. Trustworthiness was ensured based on Lincoln and Guba's criteria, addressing credibility, transferability, dependability and confirmability. Three main interconnected categories emerged (1): professional competency of healthcare staff for patient safety (values and beliefs, professional commitment, skill and technical proficiencies, individual-level risk assessment and management) (2); safety governance and organisational support (leadership commitment, supervision, open communication, learning from errors, training, policy development, teamwork climate, resource allocation, competency assurance); and (3) patient and family engagement (patient-centred empowerment and family-centred empowerment, involvement in care planning and risk management). The PSC in HHCs is shaped by the collaboration of skilled professionals, supportive organisational structures and the active participation of patients and their families. Concurrent attention to these three domains is essential for strengthening PSC in this rapidly growing sector.