Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions.

Mikaela Ridelberg,Per Nilsen,Kerstin Roback

doi:10.1186/1472-6955-13-23

Abstract

BackgroundSweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. This interview study aimed to explore perceived facilitators and barriers influencing patient safety among nurses involved in the direct provision of care. Considering the importance of nurses with regard to patient safety, this knowledge could facilitate the development and implementation of better solutions.MethodsA qualitative study with semi-structured individual interviews was carried out. The study population consisted of 12 registered nurses at general hospitals in Sweden. Data were analyzed using qualitative content analysis.ResultsThe nurses identified 22 factors that influenced patient safety within seven categories: ‘patient factors’, ‘individual staff factors’, ‘team factors’, ‘task and technology factors’, ‘work environment factors’, ‘organizational and management factors’, and ‘institutional context factors’. Twelve of the 22 factors functioned as both facilitators and barriers, six factors were perceived only as barriers, and four only as facilitators. There were no specific patterns showing that barriers or facilitators were more common in any category.ConclusionA broad range of factors are important for patient safety according to registered nurses working in general hospitals in Sweden. The nurses identified facilitators and barriers to improved patient safety at multiple system levels, indicating that complex multifaceted initiatives are required to address patient safety issues. This study encourages further research to achieve a more explicit understanding of the problems and solutions to patient safety.

Highlights

Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking
In 2011, a new law on patient safety was introduced and a government-supported financial incentive plan was initiated by Swedish Association of Local Authorities and Regions (SALAR) ), which has allocated over 2 billion SEK for 2011–2014 to county councils that carry out certain patient safety-enhancing actions and meet established requirements for specific patient safety indicators
The interview was based on two overarching questions: “What do you believe has been most important to improve patient safety where you work?” and “What do you believe hinders improved patient safety where you work?” We considered patient safety in simple terms of prevention of errors and adverse effects to patients associated with health care [15]

Summary

Introduction

Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, with increased activity over the last few years. A national study from 2008 showed that the incidence (8.6%) of adverse events in Swedish hospitals was not lower than international comparisons [2]. This brought increased focus to patient safety in Swedish health care. A vision of zero tolerance for adverse events has been discussed in Swedish health care [3,4]

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