Patient safety culture in home healthcare centres: protocol for a scoping review

Abstract

Introduction

Patient safety culture is a critical factor in improving the quality of home healthcare and preventing adverse events in patients receiving care in home health centres. However, the concept of patient safety culture in home healthcare centres is not clearly defined, and its dimensions and characteristics are still largely unknown. The aim of this scoping review is to provide a comprehensive overview of research on patient safety culture in home healthcare centres, identify related definitions and characteristics, and focus on key factors to fill the existing knowledge gaps.

Methods and analysis

This review will follow Arksey and O’Malley’s methodological framework, updated by the Joanna Briggs Institute (JBI), which comprises five stages: identifying the research question, identifying relevant studies, selecting the studies, charting the data, and collating, summarising and reporting the results. The inclusion criteria will be based on the Population, Concept and Context framework. A comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources, with no date restrictions, was conducted with the assistance of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic. The search will be continuously updated until the study is completed. In addition, we will review the reference lists of the final included studies and their citations to find further relevant studies. Studies that are duplicates and those not written in Persian or English will be excluded. The selection of studies based on the eligibility criteria will carried out by two independent reviewers who will perform a title/abstract screening followed by a full-text screening. Data extraction will be conducted using a standardised form from the JBI. Descriptive and content analyses will be conducted to identify key concepts in the literature reviewed.

Ethics and dissemination

No ethical review is required for this study. Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• A systematic search of databases and grey literature sources will identify all available evidence.

• We will apply the PRISMA-ScR reporting guidelines to ensure a rigorous approach.

• Exclusion of studies reported in languages other than English or Persian may result in important resources being overlooked.

Introduction

Home healthcare has become an important aspect of healthcare that aims to provide patients with the services and support they need. This idea is based on the realisation that the home environment can promote healing, independence and overall well-being for patients.^{1 2} Given the limited healthcare resources and inadequate hospital capacity faced by many countries around the world, particularly in developing regions, home healthcare can be a valuable solution to meet various care needs.^{2 3}

While the home environment can offer benefits for patient recovery and quality of life, the delivery of healthcare services outside of the traditional hospital setting also poses particular challenges for ensuring patient safety.² A key factor that can significantly contribute to patient safety in home care settings is the establishment of a strong safety culture, which has been shown to significantly improve patient outcomes, staff performance and organisational effectiveness.⁴ Safety culture is a multifaceted concept that encompasses a range of attitudes, practices and organisational values that together help to prevent incidents and promote patient well-being.⁵ Organisational culture encompasses shared values, beliefs, norms, and practices that shape behaviours and attitudes.⁶ Meanwhile, the safety climate captures the current perception of safety, which is influenced by the organisation’s policies and practices.^{6 7} Understanding these differences is critical in healthcare to promote a safe work environment.

In the changing healthcare landscape, the concept of a patient safety culture in home healthcare centres is not clearly defined, and is difficult to understand. This lack of clarity presents a major challenge to improving the quality of home care, where the intimate and informal nature of home care intersects with the stringent requirements of medical safety standards.

Home healthcare, with its personalised and decentralised approach, requires a more nuanced understanding of safety culture to address the unique dynamics of non-clinical care settings. The impetus for this research comes from the potential to transform home healthcare from an alternative option to a preferred choice based on a foundation of trust and safety.

To address this gap, we aim to conduct a scoping review to summarise the existing literature on patient safety culture in home care centres. The completion of a scoping review protocol is an essential requirement before the commencement of a review.⁸ The protocol is a unique manuscript that describes the aims, methodology and search strategy of the study. It must be finalised to ensure that the review is conducted systematically and efficiently.⁹ It is therefore essential that the scoping review protocol is written carefully and comprehensively to ensure success of the review. The aim of this scoping review is to clarify the concept of patient safety culture in home healthcare centres and to identify existing gaps in the current understanding and literature on this topic. The findings of this scoping review will form a basis for future research and contribute to the development of policies and strategies to improve patient safety culture in home healthcare centres.

Methods and analysis

A scoping review approach was chosen due to the broad nature of the research question in this study. This scoping review will be conducted according to the latest updated methodological guidelines of the Joanna Briggs Institute (JBI),¹⁰ building on the work of Tricco et al, in five stages:

Stage 1: Identify the research question

Stage 2: Identify relevant studies

Stage 3: Study selection

Stage 4: Chart data

Stage 5: Collate, summarise and report the results.

The study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.¹¹

Stage 1: Identify the research question

The research question is the starting point for any review and creates search strategies and roadmaps for subsequent steps, although research questions originally designed for scoping reviews are usually refined during the process of iterative development before finalisation.^{10 12} This review attempts to answer the following question:

What are the definitions, dimensions, nature and characteristics of patient safety culture in the home healthcare centre?

Stage 2: Identifying relevant studies

Inclusion criteria

The inclusion criteria for the scoping review will follow the Population, Concept and Context (PCC) framework recommended by the JBI for this type of study.¹⁰ The PCC framework is preferred to the traditional 'population, intervention, comparison, and outcome' model for systematic reviews because it does not focus on compiling evidence for a particular intervention.¹³

Populations

• Healthcare providers in the home contexts, including management, clinical and non-clinical staff.

• Patients who have received healthcare services in the home contexts, regardless of demographic characteristics.

• Family caregivers, also known as home healthcare provider associates.

Concept

This review will consider all the papers and documents that focus on patient safety culture, safety climate or organisational culture.

Context

The organisation and management of home care centres play a critical role in the culture of patient safety. It is important to examine the structure, management and leadership of these centres to fully grasp this concept. For this reason, in addition to the home care context, the home care centres that organise care should also be considered. This review will consider studies including home care context and home healthcare centres.

Types of sources

Given that patient safety culture in home healthcare centres is a concept that has been studied to a limited extent, we will include all the published studies and grey literature, regardless of publication date, to ensure that we have a comprehensive understanding of the topic. In our review, we will consider all relevant study designs, including qualitative, quantitative and mixed methods, and we will also include systematic reviews that meet our inclusion criteria. In addition, we will also consider grey literature, such as text and opinion papers, editorials, and ethical or reflective articles so that we do not miss out on valuable insights.

Exclusion criteria

All studies that are duplicates or published in languages other than Persian and English will be excluded. In addition, the authors of articles that were selected during screening and whose full text is not available will be contacted three times by email, and if they do not respond, they will be excluded from the study.

Search strategy

The search strategy followed the three-phase search process recommended by the JBI.¹⁰ It was developed in an iterative process under the guidance of an experienced health sciences librarian and validated by a second librarian using the Peer Review of Electronic Search Strategy checklist.¹⁴ In the first phase, an initial search was conducted in two electronic databases (PubMed and Scopus) that matched the research title. In the initial search, the titles and abstracts of the identified articles and the index terms used to describe the articles were reviewed. For the search strategy, we used medical terms and native language terms. In the second phase, we conducted a comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources without date range restriction on 18 May 2023, with the help of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic (online supplemental appendix 1). The results of this initial search are presented in online supplemental appendix 1, but the search process will be continuously updated until the end of the study. In the third phase, we expanded our search strategy by examining the websites of prominent patient safety and quality improvement organisations, such as The Institute for Healthcare Improvement, The National Patient Safety Foundation, Patient Safety and Quality Healthcare, The Patient Safety Movement Foundation, and The National Institute for Health and Care Excellence in the relevant field. Our approach was to use primary keywords supplemented by manual searches (browsing) to ensure comprehensive coverage. It is important to emphasise that all materials identified through these additional searches were subject to careful review. However, despite our diligent efforts, we were unable to find additional relevant information that had not already been captured through our electronic database searches. Finally, we will review the reference lists of the final included studies and their citations to find additional relevant studies. Details of how many studies were identified can be found in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow chart (online supplemental appendix 2).

Stage 3: Study selection

After searching databases, using EndNote V.X7 software, the search results are uploaded and duplicate articles are removed. First, a pilot screening process based on the inclusion criteria will be performed separately by two reviewers (AEK and FS) to revise the criteria if necessary. In this pilot screening process, a sample of 25 titles/abstracts will be screened based on their titles and abstracts and marked as ‘included’, ‘excluded’ or ‘uncertain’ by two reviewers. Any inconsistencies identified in the eligibility criteria and/or selection process will be reviewed by the reviewers. If the agreement rate in the team reaches 75% or more, the selection of articles can continue. If two people fail to reach an agreement, a third person must arbitrate (TN).¹⁴ Researchers can contact the authors of the primary studies or reviews for further information and clarification if necessary.^{10 11 14} After conducting the pilot process, we will select articles in a two-step process. The first step involves preliminary screening of articles based on their titles and abstracts. Subsequently, the full texts of the identified articles will be screened independently by two reviewers (AEK and FS). Based on the review’s questions and the aims of the study, the studies will be included or excluded according to the eligibility criteria. Articles will be excluded if they do not fulfil at least one criterion or if the full text is not available. The reasons will be documented for each article. Disagreements about inclusion or exclusion will be resolved by consensus or, if necessary, by consulting a third team member (TN).

Stage 4: Charting the data

Charting of the data is an essential step in the scoping review process as it enables a detailed analysis of the selected studies. This process involves extracting specific details relating to the title, authors, journal, publication date, sample size, study objectives, population, content, context, study approach, methodology, key findings and other relevant data in relation to the research questions of the included studies (online supplemental appendix 3). This information will then be organised and categorised to identify the key themes and questions arising from the data. The extracted data will be entered into a data extraction tool, such as Microsoft Excel table V.2013, to facilitate analysis and synthesis. To refine the data-charting form and ensure that all relevant information is correctly extracted from the included studies, a pilot test of two or three studies will first be conducted by two independent reviewers (AEK and FG) in an iterative process in which they will continually update the data-charting form. The extracted data will undergo careful quality check to resolve any discrepancies or inconsistencies between the two independent reviewers. A third reviewer (TN) will review any studies where the two independent reviewers identify a discrepancy that they cannot resolve. The authors of the papers will be contacted to request missing or additional data if necessary.

Stage 5: Collating, summarising and reporting the results

The results of the charting process will be thoroughly analysed and synthesised by our team of experts. We will then present the collected and summarised results in an organised format that includes tables, charts and a narrative summary report. The report will cover the following aspects: (1) Descriptive analysis: In this section, we will provide an overview of the existing data and present the distribution of studies based on their publication dates and countries of origin. (2) Content analysis: Here we will outline the theoretical and methodological approaches of the studies in relation to the research question and objectives. The research team will ensure that the findings are clear and concise and ambiguities are avoided for better understanding. This method will add to the existing knowledge of the research question and provide new insights into the topic. In addition, the team will confirm that the results are in line with the objectives of the study and provide valuable information to stakeholders for decision-making.

Patient and public involvement

None.

Ethics and dissemination

No ethics approval is required for this scoping review. The results will be disseminated through scientific publications and presentations at relevant conferences.