Quality and Safety in Norwegian Primary Care

• The study explores how primary care managers in Norway experience the impact of contextual factors on their daily quality and safety work.

Study Design and Setting

• A qualitative design was used, involving nine semistructured interviews at participants' workplaces.
• The analysis involved systematic text condensation.
• The study was conducted in five nursing homes and three home care services in Norway.
• Participants were female primary care managers at various levels in different units and municipalities of varying sizes and locations.

Key Findings

• Lack of time and money significantly impede quality and safety efforts, necessitating careful resource allocation.
• Networks and competence are crucial for quality and safety.
• Delegating responsibility among employees fosters engagement, improves competence, and ensures knowledge dissemination.
• External guidelines help systematize work and justify quality and safety efforts, provided they align with daily clinical practice.

Conclusions

• Contextual factors influence managers by determining the leeway in quality and safety work, budget constraints, and available resources.
• Primary care managers must actively shape their environment to improve daily practice, with further research needed on effective strategies.

Strengths of the Study

• Semistructured interviews provided in-depth insights into primary care managers' perspectives.
• The sample included diversity with regards to participants’ age, position, work experience, and type of unit.

Limitations of the Study

• The sample size was small.
• The focus was limited to managers, representing only one perspective.
• The qualitative nature means it's not exhaustive.

Addressing Resource Limitations

• Despite limitations, several participants allocated resources effectively to work.
• An example is allowing employees time to work on care plans by reassigning some of their other tasks.
• Managers worked systematically with the resources they had and set goals that were realistic.

Importance of Networks

• The participants stressed the importance of support and networks for academic and professional development.
• The participants reported being able to host in-house seminars, and workshops that addressed ways of integrating quality and safety in their units or department The participants noted the value of support services such as access to rehabilitation and medical centers.

Delegating Responsibility

• Participants found it important to delegate responsibility to employees to create motivation, engagement, and improved competence in quality and safety work.
• Participants would ensure their employees had the time to participate in relevant courses and training.

External Demands

• Participants found that external demands (like national guidelines and regulations contributed to systematizing their work and emphasizing the importance of quality work.
• Participants viewed that structured documentation was necessary to show local politicians they’d exhausted all options, and to get them to understand their needs and allocate resources.

This study explores how primary care managers in Norway experience the impact of contextual factors on their daily quality and safety work. It identifies lack of time and money as significant impediments. Networks, competence, and delegation foster engagement and improve knowledge dissemination.