title: Exploring approaches to patient safety: the case of spinal manipulation therapy.
abstract: BACKGROUND
  The purpose of this study was to gain insight into the current safety culture around the use of spinal manipulation therapy (SMT) by regulated health professionals in Canada and to explore perceptions of readiness for implementing formal mechanisms for tracking associated adverse events.
  
  
  METHODS
  Fifty-six semi-structured telephone interviews were conducted with professional leaders and frontline practitioners in chiropractic, physiotherapy, naturopathy and medicine, all professions regulated to perform SMT in the provinces of Alberta and Ontario Canada. Interviews were digitally audio-recorded for verbatim transcription. Transcripts were entered into HyperResearch software for qualitative data analysis and were coded for both anticipated and emergent themes using the constant comparative method. A thematic, descriptive analysis was produced.
  
  
  RESULTS
  The safety culture around SMT is characterized by substantial disagreement about its actual rather than putative risks. Competing intra- and inter-professional narratives further cloud the safety picture. Participants felt that safety talk is sometimes conflated with competition for business in the context of fee-for-service healthcare delivery by several professions with overlapping scopes of practice. Both professional leaders and frontline practitioners perceived multiple barriers to the implementation of an incident reporting system for SMT.
  
  
  CONCLUSIONS
  The established 'measure and manage' approach to patient safety is difficult to apply to care which is geographically dispersed and delivered by practitioners in multiple professions with overlapping scopes of practice, primarily in a fee-for-service model. Collaboration across professions on models that allow practitioners to share information anonymously and help practitioners learn from the reported incidents is needed.
authors.affiliation: Qualitative research consultant, Toronto, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Rozmovits
authors.affiliation: Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. heather.boon@utoronto.ca.
authors.forename: Heather
authors.initials: H
authors.lastname: Boon
mesh_terms: D002170:Canada; D003469:Culture; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D020393:Manipulation, Spinal / Q000009:adverse effects; D061214:Patient Safety
keywords: Chiropractic; Physiotherapy; Safety culture; Spinal manipulation