CoChat
Sign Up
Cited by 27Patient Safety and Medication ErrorsPrimary Care and Health OutcomesClinical Reasoning and Diagnostic Skills

From policy to patient: Using a socio-ecological framework to explore the factors influencing safe practice in UK primary care

Open access
Litchfield, Ian, Perryman, Katherine, Avery, Anthony, Campbell, Stephen, Gill, Paramjit, Greenfield, Sheila·2021·Social Science & Medicine
DOI 10.1016/j.socscimed.2021.113906
Open this paper in CoChat — free accountOpen PDF

Abstract

Background The recent and rapid changes in the model of primary care delivery have led to an increased focus on patient safety in what is one of the most diverse and complex healthcare settings. However, previous initiatives have failed to deliver the expected improvements, leading to calls for a better understanding of how a range of personal and contextual factors influence the decisions and behaviours of individual care providers.Methods The socio-ecological framework, successfully used in public health settings to interpret the complex influences on individual behaviours, enabled a post-hoc deductive analysis of a series of semi-structured interviews conducted with clinical staff and senior managers at a range of practices across five geographically diverse regions in England to explore their perspectives on the factors that influence safe practice.Results The five levels of the socio-ecological framework successfully helped unpick the myriad influences on safe primary care practice, including, at the Individual level, assumptions of responsibility and previous experience; at the Interpersonal, equitable communication in support of a team ethos; at the Organisational, the physical infrastructure, size and complexity of the practice; at the Community, the health profile and literacy of patients; and at the Policy, meeting the demands of competing local and national governing bodies.Conclusions Coherent, realistic and achievable goals are needed for improving patient safety in primary care addressing personal, organisational and environmental factors. Such goals and the tools and interventions designed to meet them must therefore be sympathetic to the demands on resources and the characteristics of patients, staff, and their organisations. Using the framework to interpret our findings provided much needed insight into the impact of these varying influences, and highlights the importance of recognising and communicating the relationship between specific contextual factors and the ability of individual providers to provide safe primary care.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.socscimed.2021.113906

Cites

89 of 89 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [18]18. Care Quality Commission, 2017. Review of CQC's Impact on Quality and Improvement in Health and Social Care. Care Quality Commission, 2018. What We Do | Care Quality Commission.

Cited by

Sorted by citations

Related

Authors
Litchfield, I., Perryman, K., Avery, A., Campbell, S., Gill, P., & Greenfield, S.
Affiliations
  • University of Birmingham (GB)
  • University of Manchester (GB)
  • University of Nottingham (GB)
  • University of Canberra (AU)
  • University of Warwick (GB)
Corresponding author
Litchfield, Ian
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2021-05
Volume
277
Pages
113906
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2021.113906
OpenAlex
W3150658242
Cited by
27
References
89
Citations by year
2026: 8 · 2025: 5 · 2024: 3 · 2023: 7 · 2022: 4
FWCI
4.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Funders
  • NIHR School for Primary Care Research
  • National Institute for Health Research
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
patient safety, primary care, socio-ecological framework, safe practice, clinician behavior, organizational factors, interpersonal communication, health literacy, health policy, primary care models
MeSH terms
Communication, England, United Kingdom, Humans, Primary Health Care, Policy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review