The measurement of safety in older adult care homes: A qualitative study of the perspectives of strategic-level health and social care professionals

Context: Ensuring the safety of older adults living in residential care homes is an international priority. Residents are often highly frail and vulnerable, making safety a critical concern. A growing range of organisations collect safety-related data from care homes, yet there is limited understanding of how effectively these data support learning and improvement.

Objective(s): To explore strategic stakeholders’ views on the scope, collection, and use of safety data in older adult care homes, and to identify opportunities to better support learning and improvement.

Method(s): Semi-structured online interviews were conducted with 18 purposively sampled strategic-level professionals in England, representing regulatory bodies, NHS organisations, local authorities, care home providers, and representative organisations. Data were analysed thematically.

Findings: Data collection largely reflected organisational roles in regulation or quality monitoring and focused predominantly on adverse outcomes and incidents. Care homes were subject to overlapping data requests. Barriers to effective use of safety data included siloed data collection, limited sharing between organisations and care homes, a blame-oriented culture associated with harm-focused measures, and limited capacity to analyse and use data for improvement.

Limitations: This was a small, qualitative study focused on strategic stakeholders; perspectives of care home staff, residents, and families were not included.

Implications: Improving safety assessment in care homes requires rationalising and standardising data requests, balancing harm-focused indicators with measures of proactive safety practices, enhancing data sharing, strengthening analytic capacity, and ensuring care home staff have the skills required to use safety intelligence to stimulate safety improvement.