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How do contextual factors influence quality and safety work in the Norwegian home care and nursing home settings? A qualitative study about managers’ experiences
  1. Eline Ree,
  2. Terese Johannessen,
  3. Siri Wiig
  1. Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
  1. Correspondence to Dr Eline Ree; eline.ree{at}


Objective Although many contextual factors can facilitate or impede primary care managers’ work with quality and safety, research on how these factors influences the managers’ continuous improvement efforts is scarce. This study explored how primary care managers experience the impact of a variety of contextual factors on their daily quality and safety work.

Design The study has a qualitative design. Nine semistructured qualitative interviews were conducted at the participants’ workplaces. Systematic text condensation was used for analysis.

Setting Five nursing homes and three home care services in Norway.

Participants Female primary care managers at different levels, working in different units and municipalities varying in size and location.

Results The participants cited the lack of time and money as a significant impediment to quality and safety, and these resources had to be carefully allocated. They emphasised the importance of networks and competence for their quality and safety work. Delegation of responsibility among employees helped create engagement, improved competence and ensured that new knowledge reached all employees. External guidelines and demands helped them to systematise their work and explain the necessity of quality and safety work to their employees, if they were compliant with daily clinical practice in the organisation.

Conclusions Numerous contextual factors influence the managers by determining the leeway that they have in quality and safety work, by setting the budgetary constraints and defining available competence, networks and regulation. At first glance, these factors appear fixed, but our findings underscore the importance of primary care managers acting on and negotiating the environment in which they conduct their daily quality and safety work. More research is needed to understand how these managers strategise to overcome the impediments to quality and safety.

  • quality in health care
  • patient safety
  • context
  • primary care
  • home care
  • nursing homes

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  • Contributors All authors contributed to the conception and design of the manuscript. TJ collected the data, together with other researchers (Lene Schibevaag and Torunn Strømme) and a coresearcher (Berit Ullebust) in the SAFE-LEAD project. ER and TJ conducted the systematic text condensation analysis, although SW was involved in step 1 of the analysis, in addition to discussion and refining of the results. ER made the first draft of the manuscript, while TJ and SW have critically reviewed and revised the subsequent drafts. All authors read and approved the final manuscript and the revision of the manuscript.

  • Funding The work is part of the project Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in nursing homes and home care (SAFE-LEAD Primary Care), which has received funding from the Research Council of Norway’s program HELSEVEL, under grant agreement 256681/H10, and the University of Stavanger.

  • Competing interests None declared.

  • Ethics approval The Regional Committees for Research Ethics in Norway found that the study was not regulated by the Health Research Act. The Norwegian Social Science Data Services approved the study (NSD, ID 52324). The study followed the Helsinki Declaration, and all participants gave their written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised data of the study will be stored at the Norwegian Social Science Data Services until the project is completed, and will then be available to other researchers on request.

  • Patient consent for publication Not required.

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