Patient safety measurement methods are dominated by outcome measurement, reducing them to counts of harm or adverse events. Performance measurement recognises the limitations of the sole use of outcome indicators and proposes the use of measures throughout the system, in particular the determinants of the desired outcomes. Furthermore, it promotes stakeholder engagement in the design of measures in order to understand their expectations and how they contribute. This is particularly important in healthcare services, such as the NHS case management programme, where patient contribution is growing. This programme is a response to the ageing population and the subsequent increase in complex long term conditions, aiming to deliver care in the home to empower patients so they are able to care for themselves to a greater extent. In comparison to the institutionalised setting, the home setting is relatively unexplored. Therefore, this research has provided an opportunity to examine the concept of safety in a care service with an increasing demand from a vulnerable population. The research aimed to develop a conceptual framework for safety measurement that was: 1) reflective of key stakeholders; 2) able to incorporate the system; and 3) representative of the home-delivered healthcare of the case management programme. An exploratory, sequential mixed method design within the critical realist philosophy, which was guided by the principles of performance measurement, was adopted. A case study utilising 13 interviews with nine patients and six carers (two interviews were held jointly) and three focus groups with 17 case management nurses was deployed. This enabled in-depth exploration of their perspectives regarding safety, including: their definitions of safety, who was involved, the contributing factors, and which outcomes were most important. Intriguing, important or contradictory findings were further examined using a survey (patient n=35, carer n=19 and case management nurse n=26), which aimed to determine the level of agreement with these qualitative findings and identify any statistically significant differences between the stakeholder groups. Through engagement with stakeholders, this research has established a definition of safety that represents the type of care provided by the case management programme. In particular, it recognises the importance of meeting the care needs of this patient population, acknowledging that the alternative would facilitate disease progression, exposing patients to unnecessary harm. Understanding the patient perspective has proven to be particularly important because of the level of control asserted by patients on the structure, processes and outcomes of care. This level of control is an integral component of the proposed conceptual framework. Of greatest significance is the incorporation of the patients' living environments and their resources into the structure of care, as well as the involvement of their daily self-care activities in the processes of care. Consequently, the framework is inclusive of non-traditional safety outcomes, such as functional health status, because they help sustain patient controlled structures and processes, which in turn influence traditional measures of harm. The conceptual framework is a guide to the assessment of safety in case management that specifies a range of factors that facilitate the condition of safety, providing a holistic overview of the complex, nested system of care required to manage long term conditions.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:632884 |
| Date | January 2014 |
| Creators | Jones, Sarahjane |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/64012/ |
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