Understanding the healthcare workplace learning culture through safety and dignity narratives: a UK qualitative study of multiple stakeholders’ perspectives

OBJECTIVES: While studies at the undergraduate level have begun to explore healthcare students’ safety and dignity dilemmas, none have explored such dilemmas with multiple stakeholders at the postgraduate level. The current study therefore explores the patient and staff safety and dignity narratives of multiple stakeholders to better understand the healthcare workplace learning culture. DESIGN: A qualitative interview study using narrative interviewing. SETTING: Two sites in the UK ranked near the top and bottom for raising concerns according to the 2013 General Medical Council National Training Survey. PARTICIPANTS: Using maximum variation sampling, 39 participants were recruited representing four different groups (10 public representatives, 10 medical trainees, 8 medical trainers and 11 nurses and allied health professionals) across the two sites. METHODS: We conducted 1 group and 35 individual semistructured interviews. Data collection was completed in 2015. Framework analysis was conducted to identify themes. Theme similarities and differences across the two sites and four groups were established. RESULTS: We identified five themes in relation to our three research questions (RQs): (1) understandings of safety and dignity (RQ1); (2) experiences of safety and dignity dilemmas (RQ2); (3) resistance and/or complicity regarding dilemmas encountered (RQ2); (4) factors facilitating safety and/or dignity (RQ3); and (5) factors inhibiting safety and/or dignity (RQ3). The themes were remarkably similar across the two sites and four stakeholder groups. CONCLUSIONS: While some of our findings are similar to previous research with undergraduate healthcare students, our findings also differ, for example, illustrating higher levels of reported resistance in the postgraduate context. We provide educational implications to uphold safety and dignity at the level of the individual (eg, stakeholder education), interaction (eg, stakeholder communication and teamwork) and organisation (eg, institutional policy).