DECISION QUALITY AND EDUCATIONAL NEEDS OF HEALTHCARE PERSONNEL TO IMPROVE DECISION-MAKING ABOUT MANAGING HOME HEALTHCARE HAZARDS

Purpose: This research, guided by the Griffin et al. (1999) risk information seeking and processing model, described decision-making of home healthcare personnel (HHPs) for handling their own health and safety needs in context of managing environmental home hazards. 

Method: Focus groups individual interviews were done with 68 occupationally diverse HHPs who also completed the 38-item Modified Home Healthcare Worker questionnaire (M-HHCW; Gershon, Canton, et al., 2008) with questions on demographics, types of home healthcare tasks performed, any injuries experienced, types of hazards encountered, history of occupational safety training, and personal health history. Interviews explored perceptions of hazards experienced in the home healthcare setting, and perspectives on training needs, content, and training constraints in regard to home healthcare safety hazards. Discussed experiences with hazards were further explored with a standard probe: “How did you manage that?” Audio-recorded interviews were transcribed, validated for accuracy, and independently coded by two coders with coding discrepancies resolved to 100% consensus. Data were thematically analyzed for types of hazards and management dilemmas reported, hazard management decision-making, and level of decision quality (optimal, mixed, suboptimal). 

Result: HHPs described 353 instances of hazard management dilemmas within 394 specific types of hazards situations, clustering within three overall hazards categories: electrical/fire, lift/slip/trip, and environmental exposures. Multiple types of stressful “making do” decisions were described in which decision-making was influenced by resource constraints. Within the three overall hazards categories, a majority of decisions were classifiable as mixed or suboptimal quality (72.5%, 68.5%, 63.5%, respectively), for which the reported decisions: (a) may not have been effective in mitigating the hazard; (b) involved significant tradeoffs for the health and safety needs of the HHP and/or the client; and/or, (c) involved setting aside the needs of the HHP and/or client in order to “make do.” Rank order for decision quality by overall hazards categories was consistent with extent of occupational safety training reported on the M-HHCW. 

Conclusion: Perceived hazard characteristics and decision-making about managing hazards are influenced by HHP perceptions of hazard characteristics, resources, prior hazard experience, affective responses, and information sufficiency factors reflected in the Griffin et al. model. Improved decision-making about hazards and policy development and implementation to improve HHP training and safety can promote improved health, safety, and financial cost outcomes in the rapidly-expanding HHP workforce.