Exploration of Patient Safety Phenomena in Rehabilitation and Complex Continuing Care

Patient safety has been relatively unexplored in rehabilitation and complex continuing care (CCC) settings. From the perspectives of staff members, this qualitative study aimed to explore patient safety phenomena that exist within rehabilitation/CCC and to identify the characteristics of the current workplace culture that act as enablers of or barriers to patient safety. Sixty-six staff members in a large, multisite, academic rehabilitation/CCC health centre volunteered to participate in one of six interprofessional focus groups, designed to model patient care teams that exist within the clinical programs; one focus group was also conducted with support services staff. Thematic analysis revealed that rehabilitation/CCC settings present with distinct patient safety issues due to the unique and increasingly complex populations that are served, and the place of rehabilitation/CCC along the continuum of care. Enablers and barriers identified related to teamwork, culture, resources and organizational and individual responsibility. Results of this study have helped form the foundation for future patient safety initiatives within our settings, with clear emphasis on enhancing an open and just culture in which to discuss safety issues through development of improved leadership–staff relations, teamwork and communication and clearer processes and structures for accountability. The approach to addressing these issues must fit within our rehabilitation models of care. Introduction and Background While patient safety concerns have existed for decades, the sentinel report issued by the Institute of Medicine in 1999 entitled To Err Is Human: Building a Safer Health System (Kohn et al. 1999) catalyzed much of the current momentum in the area of patient safety. Much of the literature to date has focused on detecting, reporting and managing adverse events within acute care settings, as these are sites of a variety of risky medical procedures and extensive drug treatment with a high potential for errors and accidents. The literature has highlighted the issue of underreporting adverse events in acute care settings (Cullen et al. 1995) and the need for improved measurement and reporting (Baker and Norton 2001; Wong and Beglaryan 2004). However, for different settings such as rehabilitation and complex continuing care (CCC), reporting safety events may be compounded by the lack of knowledge of unique patient safety phenomena that exist within these settings, where there are differences in clinical issues, patient populations, team composition, reduced availability of physicians, higher involvement of non-nurse practitioners (e.g. rehabilitation therapists) and greater participation of patients and family members within a client-centred model of care. The rehabilitation patient safety literature has focused more on particular processes and outcomes, for example, falls prevention (Simpson et al. 2003; Theodos 2003) and the use of physical Exploration of Patient Safety Phenomena in Rehabilitation and Complex Continuing Care Carol Fancott, Karima Velji, Elaine Aimone and Lynne Sinclair