Staff perceptions of patient safety within three Ambulance Service NHS Trusts in England: an exploratory qualitative study


Student thesis: Doctoral Thesis


Background: Research exploring the perceptions of patient safety has been conducted in hospitals and primary care settings, while it is mostly absent in the ambulance and emergency services. Exploring staff perceptions of patient safety is essential as it can highlight their concerns and priorities, providing an understanding of issues they consider significant and necessary to support the development of research, policy, education and practice. This study aimed to gain insight into the perceptions of staff across all organisational levels and in multiple Ambulance Service NHS Trusts in England.

1.) To explore the meaning of ‘patient safety’ to staff within three Ambulance Service NHS Trusts in England, and how this differs between NHS Trusts and organisational levels.
2.) To investigate staff perceptions of risks to patient safety.
3.) To explore staff perceptions of reporting patient safety incidents within the NHS Ambulance Services.

Methods: An exploratory generic qualitative approach was adopted utilising semi-structured interviews to capture the perceptions of patient safety from staff in three Ambulance Service NHS Trusts in England. Fourteen to fifteen participants across three distinct organisational levels (operational, management and executive) represented each NHS Trust, with fortyfour interviews conducted in total. The Framework Method was used for the analysis of the large qualitative dataset.

Findings: Five overarching themes emerged from the interviews with participants, including Varied Interpretation of Patient Safety, Significant Patient Safety Risks, Reporting Culture Shift, Communication and Organisational Culture, representing the overall staff perceptions of patient safety in the NHS Ambulance Services. It was evident that the perceptions of patient safety varied between different organisational levels but was largely consistent within these levels across all three Ambulance Service NHS Trusts.

Conclusion: The findings demonstrate that participants believe the NHS Ambulance Services are becoming safer for patients, thereby indicating an awareness of some of the historical issues with patient safety and the steps taken to address them. In particular, the perception that the reporting culture had improved substantially in recent years, was of the most notable and had not been captured in any similar research. The inclusion of several levels of staff and three distinct NHS Trusts provided an in-depth understanding of the perceptions of patient safety in the NHS Ambulance Services. Given the consistency of the responses across organisational levels and NHS trusts, the identified issues from this study may be generic and applicable to other ambulance and emergency services.

Date of Award27 Apr 2020
Original languageEnglish
Awarding Institution
  • Edge Hill University
SupervisorSALLY SPENCER (Director of Studies), CAROL KELLY (Supervisor) & PARESH WANKHADE (Supervisor)


  • Perceptions
  • Patient safety
  • National Health Service
  • NHS
  • Ambulance services
  • Paramedics
  • Healthcare staff
  • Generic qualitative inquiry

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