From policy to patient: Using a socio-ecological framework to explore the factors influencing safe practice in UK primary care

Litchfield, Ian; Perryman, Katherine; Avery, Anthony; Campbell, Stephen; Gill, Paramjit; Greenfield, Sheila

Abstract

Background
The recent and rapid changes in the model of primary care delivery have led to an increased focus on patient safety in what is one of the most diverse and complex healthcare settings. However, previous initiatives have failed to deliver the expected improvements, leading to calls for a better understanding of how a range of personal and contextual factors influence the decisions and behaviours of individual care providers.

Methods
The socio-ecological framework, successfully used in public health settings to interpret the complex influences on individual behaviours, enabled a post-hoc deductive analysis of a series of semi-structured interviews conducted with clinical staff and senior managers at a range of practices across five geographically diverse regions in England to explore their perspectives on the factors that influence safe practice.

Results
The five levels of the socio-ecological framework successfully helped unpick the myriad influences on safe primary care practice, including, at the Individual level, assumptions of responsibility and previous experience; at the Interpersonal, equitable communication in support of a team ethos; at the Organisational, the physical infrastructure, size and complexity of the practice; at the Community, the health profile and literacy of patients; and at the Policy, meeting the demands of competing local and national governing bodies.

Conclusions
Coherent, realistic and achievable goals are needed for improving patient safety in primary care addressing personal, organisational and environmental factors. Such goals and the tools and interventions designed to meet them must therefore be sympathetic to the demands on resources and the characteristics of patients, staff, and their organisations. Using the framework to interpret our findings provided much needed insight into the impact of these varying influences, and highlights the importance of recognising and communicating the relationship between specific contextual factors and the ability of individual providers to provide safe primary care.

Citation

Litchfield, I., Perryman, K., Avery, A., Campbell, S., Gill, P., & Greenfield, S. (2021). From policy to patient: Using a socio-ecological framework to explore the factors influencing safe practice in UK primary care. Social Science and Medicine, 277, https://doi.org/10.1016/j.socscimed.2021.113906

• Journal Article Type: Article
• Acceptance Date: Apr 1, 2021
• Publication Date: Apr 18, 2021
• Deposit Date: Oct 13, 2023
• Journal: Social Science and Medicine
• Print ISSN: 0277-9536
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 277
• DOI: https://doi.org/10.1016/j.socscimed.2021.113906