Safety in home care: a broadened perspective of patient safety

TLDR

Home care is rapidly expanding in Canada, yet patient safety research has largely focused on institutional settings, leaving a critical knowledge gap and underscoring the need to understand safety in this complex, autonomous, and under‑regulated sector. The paper aims to describe the landscape of safety in Canadian home care. The study used a pan‑Canadian initiative comprising a literature review, 20 key informant interviews, and an invitational roundtable, with data synthesized via content analysis. The authors found that patient safety in home care is a systemic issue requiring multiple change processes, with organizational culture, workplace factors, and patient participation being critical, and identified key themes such as interdependent relationships, unregulated settings, multidimensional safety, declining prevention focus, and human resource challenges.

Abstract

Home care is the most rapidly growing segment of the Canadian healthcare system. Overwhelmingly, research on patient safety has been conducted within institutional settings, resulting in a significant knowledge gap about safety in homecare. Given the dramatic increase in the amount, acuity and complexity of health care being provided in the home and community, it is essential to develop our understanding of safety in this sector. The objective of this paper is to describe the landscape of safety in home care in Canada. This pan-Canadian initiative included three phases: a literature review, 20 key informant interviews and an invitational roundtable. Data were synthesized using a content analysis approach. Patient safety is a failure of systems rather than of humans; there are many change processes required to create safe environments; organizational culture and workplace factors are critical. Patients have a key role to play in their care and thus must be part of the patient safety discourse. Themes central to safety in home care are: the inextricably linked relationships and communication among clients/families and caregivers/providers; unregulated and uncontrolled settings, autonomy and isolation; the multidimensionality of safety (physical, emotional, social, functional); a diminishing focus on prevention, health promotion and chronic care; challenges of human resources and maintenance of competence. Addressing safety in home care and mitigating the risks presents unique challenges and requires a major rethink of underlying institutionally oriented assumptions and guiding frameworks.