A qualitative study of what care workers do to provide patient safety at home through telecare

Randi Stokke,Hege Andreassen,Aud Obstfelder,Jørn Isaksen,Line Melby

doi:10.1186/s12913-021-06556-4

Abstract

BackgroundIn 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.MethodsThe 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.ResultsWe 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.ConclusionsWe 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.

Highlights

In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work
The social alarm To explore the efforts of care workers to foster patient safety through telecare, we have focused on the social alarm as a typical example of telecare used to safeguard frail people living independently at home
The home care workers created a chronological story of the technology in use, by describing how they worked with the social alarm to ensure safety for the patients

Summary

Introduction

The work of keeping the patient safe and reducing the risk of harm is defined as safety work. There is, a need for more knowledge about the safety work performed in home care, especially in light of the care services becoming increasingly complex and thereby involving more risks for the patients [2,3,4] To address this gap, in this paper we draw on sociological insights on healthcare work and organisation, to explore the work performed to ensure patient safety in home care services in depth. In this paper we draw on sociological insights on healthcare work and organisation, to explore the work performed to ensure patient safety in home care services in depth In their pivotal studies, Strauss et al [5] point to care workers’ engagement in different kinds of work activities, and different types are outlined. For example, Davina Allen [6] have followed this line of argumentation, emphasising that ‘organising work’ is a vital part of care work, and for positive patient outcome and experiences

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