A meta-ethnography of staff experiences of raising concerns about quality and safety in residential aged care.

BACKGROUND AND

objectivesSpeaking up about quality and safety issues can protect older people and support learning in health and social care systems. In aged care, staff work in diverse roles to deliver care to residents with complex care needs. This meta-ethnography aimed to synthesize evidence on staff experiences of raising concerns about quality and safety in long-term residential aged care. RESEARCH DESIGN AND

methodsWe included qualitative studies examining staff experiences of speaking up, incident reporting, and whistleblowing. Five databases were searched. The seven phases of meta-ethnography were conducted to translate first- and second-order constructs into third-order constructs and a line-of-argument synthesis.

resultsThirteen articles of 11 studies were synthesized to reveal four third-order constructs: (1) Sensemaking of a concern, (2) Organizational cultures determine how they are voiced, heard and responded to, (3) Systemic resources shape and constrain possibilities for voicing, and (4) Normalization of poor care and loss of moral agency in organizations that respond with indifference. Raising concerns was a dynamic, recursive process encompassing phases of recognizing, voicing, and organizational responding. Where quality and safety issues were normalized, individualized, or met with limited action, staff described moral distress, disengagement, and, in some cases, exit from the organization or sector. DISCUSSION AND IMPLICATIONS: Raising concerns in residential aged care is a dynamic process shaped by interrelated individual, organizational and systemic factors. Speaking up interventions need to go beyond skills training to address phases of recognizing care quality issues and how organizations respond when they are raised.