"Doing Our Best for Patient Safety": An International and
Interprofessional Qualitative Study with Spinal Manipulative
Therapy Providers in Community-based Settings

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

FROM:   Musculoskelet Sci Pract 2021 (Dec): 56: 102470 ~ FULL TEXT

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Martha Funabashi • Michelle M Holmes • Katherine A Pohlman • Stacie Salsbury • Maeve O'Beirne • Sunita Vohra • Silvano Mior

Division of Research and Innovation,
Canadian Memorial Chiropractic College,
6100 Leslie St., Toronto, ON, M2H 3J1, Canada

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Background:   Patient safety research is expanding from hospitals to community-based healthcare settings. Knowledge gaps persist among manual therapy professions that may impede patient safety initiatives within musculoskeletal care settings.

Objectives:   To describe perceptions of patient safety among chiropractors and physiotherapists who provide spinal manipulation therapy (SMT).

Design:   Qualitative descriptive study.

Method:   Cross-sectional data were collected using the SafetyNET Survey to Support Quality Improvement. SMT providers (n = 705) in 3 countries completed surveys, with 84 providing written responses to an open-ended question about patient safety. Qualitative thematic analysis described providers' perceptions about patient safety within their practice.

Results:   SMT providers' perceptions were influenced by professional, patient, and practice setting factors. Five themes and 10 supporting categories were developed. Doing Our Best for Patient Safety concerned Avoiding Mistakes and Prioritizing Safety. Putting Patients First focused on Developing Relationships and Individualizing Care. Working and Learning Together advocated for Interprofessional Communication and Collaborative Learning. Organizing Practice Processes emphasized Standardizing Procedures and Benchmarking Progress. Considering Practitioner Identity highlighted how Recognizing Difference among SMT providers and Challenging Fears of other healthcare professionals and patients about SMT were important for enhancing patient safety.

Conclusion:   Findings align with World Health Organization guiding principles that the nature of healthcare settings influence patient safety strategies. Most responses focused on individual strategies to prevent adverse events. However, this approach may overlook the benefits of identifying and documenting adverse events, setting time to discuss adverse events with clinic members, standardizing clinical practices, and building transparent patient safety cultures across healthcare professions and settings.

Keywords:   Patient safety; Perception; Qualitative research; Spinal manipulation.

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Commentary From Palmer College:

Patient safety is a healthcare discipline that focuses on preventing harm to patients during the care process. While spinal manipulative therapy (SMT) is a relatively safe treatment for many patients with spine-related musculoskeletal conditions, SMT is not without its risks and harm has been reported by patients. The purpose of this qualitative study was to describe how SMT providers think about patient safety within their community-based practice settings.

Our study used the SafetyNET Survey, a validated instrument to measure patient safety attitudes and opinions of community based SMT providers, to support quality improvement. The study surveyed 705 SMT providers, which included chiropractors and physical therapists, with 58 of them contributing with fully written responses to a voluntary open-ended patient safety question.

Five Central Themes and ten supporting Categories were developed.

• SMT providers are committed to “Doing Our Best for Patient Safety”. Many providers described their main patient safety actions as Avoiding Mistakes and Prioritizing Safety in clinical practice.

• “Putting Patients First” described the important role of patient-centered care. SMT providers sought to maintain patient safety by Developing Relationships and Individualizing Care.

• SMT providers who worked in group settings highlighted “Working & Learning Together” for patient safety. Interprofessional Communication and Collaborative Learning included the ideas of teamwork, staff meetings to discuss patient safety concerns, and continuing education.

• “Organizing Practice Processes” focused on Standardizing Procedures, such as clinic protocols, and Benchmarking Progress through ongoing documentation and evaluation of patient harms.

• “Considering Practitioner Identity” was important for patient safety programs. SMT providers thought that Recognizing Difference between provider approaches was important across and within professional groups. Challenging Fears about SMT held by other health professionals and patients was also warranted.

Take Home Message

Our study concluded that SMT providers do not share a common outlook concerning patient safety. The perspectives chiropractors and physical therapists have about patient safety are influenced by their professional background, clinical experience and environment, and patient factors. Current practice settings may often limit the time and resources practitioners have at their disposal to engage proactively in patient safety initiatives.

Practical Application

To learn how to reduce avoidable harms to patients, read The WHO Global Patient Safety Action Plan.
https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan

Reference

Funabashi M, Holmes MM, Pohlman KA, Salsbury S, O’Beirne M, Vohra S, Mior S. (2021).
“Doing our best for patient safety”: an international and interprofessional qualitative study with spinal manipulative therapy providers in community-based settings.
Musculoskeletal Science and Practice, 56: 102470. PMID: 34735865.
https://www.sciencedirect.com/science/article/abs/pii/S2468781221001545?via%3Dihub

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