Exploring perceptions and approaches of registered managers regarding clinical safety in care homes in the UK

Context: Around 400,000 people currently live in care homes with increasing complexity of care needs and comorbidities. Despite this, there is a paucity of research that asks questions about how the care and clinical safety of this vulnerable population are managed. Objective: The aim of this research was to understand how registered care home managers approach clinical safety and what they feel helps or hinders them in this. Methods: The research took a Heideggerian interpretative phenomenological approach, embracing the closeness of the researcher to the participants and the subject matter to uncover rich and detailed findings. Five registered managers of care homes owned by one provider participated in semi-structured interviews between March and May 2020. Three of the interviews took place in the managers’ care homes, and, due to coronavirus restrictions, two were undertaken via video conferencing software. Findings: Thematic analysis of the data generated unexpected findings demonstrating the significant impact on clinical safety in care homes caused not by the managers themselves, but by external forces, including regulation, shortcomings in the structure of the health and social care system in the UK and complex relationships between care homes and other agencies. Limitations: The strengths (e.g., in-depth data) and limitations (e.g., only including care homes in one area) of this phenomenological qualitative study are discussed. Implications: The findings led to recommendations that further research and reviews should be undertaken urgently to understand these factors in more detail. This would provide valuable guidance to inform system-wide reform to ensure better clinical safety for care home residents.