Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

Elisabeth Severinsson,Anne Lise Holm

doi:10.4236/ojn.2015.55043

Abstract

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

Highlights

Depression in later life is a major public health issue
Despite indications of positive associations between their experiences and safety, the participants reported several structural components that contributed to unsafe care
The participants’ experiences of quality and safe care were at different levels

Summary

Introduction

Depression in later life is a major public health issue. A sense of safety and security at home is important for the depressed elderly patients themselves and for their family members [4]. Norwegian policy for depressed elderly patients aims to enhance their chances of living an active life in their own home in combination with support from the health and social care services [5] [6]. A large body of literature on evidence-based improvement strategies has been developed to enhance the quality of care and strengthen the safety culture. According to Øvretveit [8], evaluation of health interventions, improvements and their implementation is important. There are several implementation strategies for improving the quality of care and ensuring patient safety [9]. Implementation research on patients’ experiences of care and safety is scare

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