How do care home staff make sense of safety?

Care homes are a setting that have been largely neglected by health researchers, particularly in the area of patient safety. In response to evidence of poor practice within this sector, approaches to safety have been translated from large NHS organisations that often take a bureaucratised approach to patient safety and applied to care homes with little consideration of whether these methods are appropriate. Drawing on qualitative data from 4 months of ethnographic fieldwork and 33 interviews with staff, this paper explores how care home staff make sense of safety, and how they construct notions of safety and safe practice. Safety practices in care homes are varied and largely centred on, and conditioned by the relatively low-skilled workforce. These organisations are highly differentiated, ranging from small family run businesses, to large chains. Care home staff did not consider safety to relate to organisational structures or processes, but this was instead an aspect of the physical environment. Patient-centred care was articulated and demonstrated to be the focal point of how care home staff identified risk and ensured safety. The paper shows that care home staff understand safety in a very different way to hospital staff who work within the NHS bureaucracy. If we want to improve safety in care homes, this research suggests that there may be limited benefit to adopting approaches from hospital settings and applying these to care homes. A more individualised and person-centred approach to patient safety is essential.