Associations between safety climate, quality practices, quality of care and client safety in home care: A multicenter cross-sectional study

Identifying relevant quality practices and assessing safety climate as potential factors influencing the quality of care and safety in home care are essential for informing targeted evidence-based improvements. Studies on safety climate, quality practices, and their association with employee- and client-rated quality of care and client safety in home care are scarce. The objectives of this study were (1) to describe safety climate and quality practices in home care organizations in Switzerland and (2) to assess how safety climate and quality practices are related to employee- and client-rated quality of care and employee-rated client safety. This was a sub-study of a national multicenter cross-sectional study conducted in Switzerland between January and September 2021 among home care managers, employees, and clients. Employee-rated quality of care and client safety ratings ranged from 1 (‘very poor’) to 4 (‘very good’). Client-rated quality of care ranged from 0 (‘worst possible care’) to 10 (‘best possible care’). To assess the relationship between safety climate, quality practices, and quality of care, and client safety ratings, we ran binary multilevel logistic regression models. We analyzed data from 88 home care organizations, 3223 employees, and 1466 clients. Organizations had a mean safety climate score of 78.5 (SD 16.4) (scale 0–100). The most frequently reported quality practice was the presence of Standard Operating Procedures for emergency situations (72.7%), whereas quality certification was the least common (19.3%). Higher safety climate scores were statistically significantly associated with increased odds of better employee- (OR 1.07, 95% CI 1.06, 1.08) and client-rated (OR 1.03, 95% CI 1.01, 1.06) quality of care and higher employee-rated client safety (OR 1.06, 95% CI 1.06, 1.07). Working in organizations with Standard Operating Procedures for emergency situations was associated with increased odds of better employee-rated quality of care (OR 1.42, 95% CI 1.01, 2.00) and client safety (OR 1.33, 95% CI 1.05, 1.68). Additionally, working in organizations that measure quality indicators was associated with increased odds of employees reporting better client safety (OR 1.32, 95% CI 1.06, 1.63). Our findings highlight the relevance of safety climate and quality practices, such as Standard Operating Procedures for emergency situations and the monitoring of quality indicators, for quality of care and safety in home care. Further research is needed to assess the causal relationships between quality practices, safety climate, and quality of care to identify important areas for strengthening the quality of home care. Key quality practices and stronger safety climate are associated with very good quality of care and client safety in home care.