Skip to main content

Research Repository

Advanced Search

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives

Litchfield, Ian; Gill, Paramjit; Avery, Tony; Campbell, Stephen; Perryman, Katherine; Marsden, Kate; Greenfield, Sheila

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives Thumbnail


Ian Litchfield

Paramjit Gill

Stephen Campbell

Katherine Perryman

Kate Marsden

Sheila Greenfield


Background: Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice.

Methods: The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability.

Results: The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice’s local environment such as overlapping initiatives orchestrated by their CCG.

Conclusions: The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation.


Litchfield, I., Gill, P., Avery, T., Campbell, S., Perryman, K., Marsden, K., & Greenfield, S. (2018). Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives. BMC Family Practice, 19(1), Article 72.

Journal Article Type Article
Acceptance Date May 2, 2018
Online Publication Date May 22, 2018
Publication Date May 22, 2018
Deposit Date Mar 1, 2019
Publicly Available Date Mar 4, 2019
Journal BMC Family Practice
Electronic ISSN 1471-2296
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Issue 1
Article Number 72
Keywords patient safety; primary care; general practice; health services research; quality improvement
Public URL
Publisher URL
Additional Information