Barriers and Challenges of Undertaking Patient Safety Reviews in Rural Health Services: A Qualitative Study

OBJECTIVE: This study examines the barriers and challenges that affect the efficiency and effectiveness of patient safety reviews in rural healthcare services and proposes co-designed improvement strategies. SETTING: Rural health services in four Australian states and territories. PARTICIPANTS: Health service staff working in rural Australia. METHODS AND DESIGN: We used a descriptive qualitative design. Data were drawn from a broader project that explored health service staff's perspectives on patient safety reviews. Participants of the focus groups were recruited from health services across four states and territories. Findings were thematically analysed and then informed co-design workshops that developed strategies to strengthen reviews. RESULTS: Findings show that (1) Health service staff often lack adequate oversight, monitoring and support due to the wide geographic spread of facilities, limited staffing, and resources. (2) Cross-border reviews and reliance on locum doctors and Visiting Medical Officers (VMOs) increase administrative complexity, particularly in their engagement with review interviews and the development and implementation of recommendations. (3) Rural health services frequently lack access to external subject matter experts (SMEs) and consumer representatives on review teams. When external SMEs are involved, they bring subject expertise, but they may not be familiar with rural healthcare contexts. There are limited internal SMEs to draw on due to small and close communities and potential conflict of interests risks a lack of diverse perspectives. Nurses are often the people who coordinate patient safety reviews and follow up implementation. However, their ability to influence doctors or drive broader changes was described as limited, particularly given ongoing workforce shortages and hierarchical dynamics. (4) Rural health services are further constrained by logistical challenges and resource constraints such as outdated facilities and diagnostic methods. CONCLUSION: This paper highlighted key barriers to patient safety reviews in rural health services including resource limitations, workforce shortages, reliance on locums and VMOs and the challenges of dispersed facilities. PATIENT OR PUBLIC CONTRIBUTION: Patient and public engagement was integrated into the design and delivery of the study. A panel of six consumers served as an advisory committee, assisting with framing research questions and offering their insights from working with health services staff on the review teams.