Safe and high-quality care for older people with dementia and/or delirium in hospital: A video reflexive ethnography

Older people with cognitive impairment represent over one-third of people over 65 years who are hospitalised. Relative to people without cognitive impairment, they are at greater risk of: dying; re-admission; and longer hospital stays (Reynish et al., 2017). Thus there is an urgent need to understand and promote the conditions that enable safe and high-quality care for people with dementia and/or delirium and their families. This is particularly important because much of the research on patient safety focuses on compliance models and eliminating adverse events (Jerak-Zuiderent, 2012). Some researchers and clinicians now realise the need to redirect (at least some of) this attention to strength and opportunity (Mesman, 2011). This focus on strengths is the point of departure for this study. Using positive organisational scholarship in healthcare (Dadich et al., 2013) and video reflexive ethnography (Iedema et al., 2013), this study investigated how patient safety and high-quality care are enacted within a specialist geriatric management and evaluation unit (GEM) for older Australians with cognitive impairment. This involved the use of video to learn from patients, family members, clinicians, and ancillary staff. Findings revealed some of the key, yet taken-for-granted components of patient safety and high-quality care for people with cognitive impairment. These include: staff safety; a capacity to juggle competing risks; active engagement; a meshed team, whereby palliative and dementia care are entwined; and a focus on care – not the clock. These components are relevant to non-specialist hospital units, and can be adapted and/or refined, accordingly.