Patient safety culture in home care and its related factors and outcomes: a scoping review.

backgroundPatient safety culture is crucial to ensuring the quality and safety of healthcare. Assessing safety culture raises awareness of patient safety, identifies areas for improvement, and supports tracking changes over time. Given the increasing growth of home care, the complexity of care, and its unique characteristics, understanding safety culture in home care is essential to informing practice and guiding further research. We therefore aimed to identify instruments used to measure patient safety culture in home care, including its associated factors and outcomes.

methodsWe conducted a systematic search of MEDLINE/PubMed, CINAHL, PsycINFO/Ovid, EMBASE/Ovid, and Web of Science and then a citation tracking in March 2024. Two reviewers independently screened the records for eligibility criteria. We included studies that measured patient safety culture from the perspective of healthcare professionals working in home care. The included studies were narratively summarized, and the findings are presented through descriptive texts and tables.

resultsThe screening of 1922 articles and citation tracking resulted in 13 articles that met the inclusion criteria. Twelve studies employed self-reported questionnaires and one used interviews. The most frequently used questionnaires were adaptations of the Nursing Home Survey on Patient Safety Culture and Safety Attitudes Questionnaire. Commonly assessed dimensions included teamwork, communication, management, and organizational learning, whereas job satisfaction and stress recognition were less frequently assessed. The studies examined the association of both individual (e.g., age, work experience) and work-related factors (e.g., weekly working hours, transformational leadership) with safety culture. The outcomes analyzed included person-centered care, the overall perceptions of patient safety, and the global reporting of patient safety events.

conclusionsDifferent instruments have been used to measure safety culture in home care, but none of them have been specifically developed for home care, and there is no agreement on which dimensions to include. Evidence on the associated factors and outcomes is scarce and inconclusive. Further research is needed to understand the concept of safety culture, including associated factors and outcomes. Applying mixed-methods and longitudinal study designs could provide a more comprehensive understanding of safety culture and support evaluating and developing strategies to improve it in home care. REVIEW REGISTRATION NUMBER: Zenodo: https://doi.org/10.5281/zenodo.10779093 .