title: Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study.
abstract: BACKGROUND
  Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap.
  
  
  METHODS
  Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework.
  
  
  RESULTS
  Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment.
  
  
  CONCLUSIONS
  Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety.
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin University, Warrnambool, Warrnambool, Victoria, Australia.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hernan
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Giles
authors.affiliation: School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Department of Surgery, Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Johnson
authors.affiliation: Chronic Illness Alliance, Camberwell, Victoria, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Walker
authors.affiliation: Deakin Population Health Strategic Research Centre, Deakin University, Burwood, Victoria, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Dunbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D015984:Causality; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D061214:Patient Safety; D011320:Primary Health Care; D036301:Qualitative Research
keywords: Patient safety; Primary care; Qualitative research