How Work Culture Contributes to Client Harm in Social Care: An Analysis of Reports from the Client Safety Reporting System in Finland

ABSTRACT

The ethical obligation of social services professionals is to ensure that clients are not repeatedly harmed by the same risks. This study examines reports classified as actions harmful to clients due to work culture and the measures taken by managers in Finnish social services. The data used were the reports submitted by social services professionals based on reporting obligations to the SPro client-safety-reporting system and managers’ measures documented in the reports. The reports (n = 1,433) were submitted from October 11, 2016, to December 31, 2020; those related to harmful work culture (n = 95) were selected and analyzed using inductive content analysis and quantification. The results showed that, based on professionals’ perceptions, harmful work culture was linked to cooperation, information flow, resources, service or care implementation, and individuals’ actions. Managers often decided to discuss reported events within the unit. More research is needed on harmful work culture from clients’ perspectives and the effectiveness of measures to eliminate observed risks.

Practice Points

• Based on professionals’ perceptions, work culture can harm social services clients. However, more research is needed from the client’s perspective.

• The most frequently reported events related to harmful work culture were linked to the flow of information.

• The most common measure recorded by the managers was a discussion of the reported events within the unit, but more research is needed on the final implemented changes in practice.

KEYWORDS:

• Client safety
• reporting system
• risk
• social care
• work culture

Introduction

Mistakes are inevitable in all human activities, and social services are no exception. The quality of social services and professionals in the field is reflected by whether mistakes and risks are detected and managed from the outset (Sicora et al., 2021). Since 2016, Finnish law has required all social service professionals to report any observed risks and threats in implementing social care services. Social welfare includes the promotion of social safety and social well-being as well as social services. (Social Welfare Act, 1301/2014). The reporting obligation aims to fulfill the legal rights of social services clients. The web-based client safety reporting system, SPro, has been developed as a tool for professionals to report information on all observed risks or threats in implementing social care services.

In Finland, social welfare is based on the Nordic welfare state model, and social and health policies emphasize preventive actions to secure people’s welfare. Social work forms part of social and healthcare services and includes various services for promoting and maintaining the social well-being and safety of citizens and communities. Additionally, the social welfare system aims to protect vulnerable groups. Social care in Finland encompasses a wide range of services, such as child welfare, children’s home activities, care for people with disabilities, home care, residential care facilities, substance abuse housing services, substance abuse rehabilitation, housing services for mental health clients, and 24-hour social services, and is provided to service users of all ages. (The Social Welfare Act, 1301/2014.) Thus, data collected from the Finnish social services’ client safety reporting system covers a wide range of services.

Ensuring client safety entails the organization, production, and implementation of social services in a manner that does not compromise the client’s social, economic, physical, or psychological safety (The Ministry of Social Affairs and Health, 2022). The Client and Patient Safety Strategy and Implementation Plan 2022–2026 in Finland highlights the importance of enhancing both client and patient safety in health care (The Ministry of Social Affairs and Health, 2022). However, client safety in social care remains under-researched, and more information is required as to whether clients’ legal rights are realized as stipulated in the Social Welfare Act (1301/2014).

This qualitative study examines the risks and threats reported by social services professionals to the SPro system. These are classified as “actions harmful to the client due to the work culture” by professionals. The study also describes professionals’ evaluations of the harmfulness of these events to clients and the documented actions taken by managers after the risks were reported. This is one of the first studies using data from the SPro system. The effects of work culture on social service clients have not previously been studied in Finland. The research questions are: 1) “What types of actions that are harmful to clients due to the work culture have been reported by professionals in social services?” and 2) “What kind of actions were taken by social services employers after risks were reported?” The results of this study provide novel insights into the work culture in social services and its impact on clients from the perspectives of professionals. The findings can be used to improve the course of action of social services by addressing the issues identified in the results.

Background

Schein (1984) devised one of the most frequently employed models for identifying the various levels of organizational culture. According to Schein, organizational culture is composed of three levels, namely, artifacts, espoused beliefs and values, and fundamental underlying assumptions. Schein’s model clarifies the degree of visibility of the various levels of organizational culture. Organizational artifacts are the visible aspects of organizational culture that can be observed or otherwise perceived, such as the language used in the organization. However, the significance of artifacts for the organization or its members cannot be deduced. Values and beliefs are implicit regulations that establish norms for organizational behavior. The final level of Schein’s model comprises the fundamental assumptions, which are unconscious and deeply entrenched beliefs and values (Schein, 1984). According to Glisson (2007) organizational culture specifies how people act and the typical ways of doing things within an organization. Organizational climate, on the other hand, pertains to the shared perceptions of employees regarding how their work and work environment affect them (Glisson, 2007). Hence, the type of organizational climate is determined by the collective experiences of employees in the work environment (Glisson, 2015).

The scope of the “work culture” concept in this study encompasses organizational culture and climate. This is based on the data used, which is obtained from professionals who observe and report on risks and threats in the implementation of clients’ social welfare. Within the SPro system, events are classified as “work-culture related” based on the assessment of professionals. It is worth noting that the SPro system does not define work culture during reporting, and the selection of the predefined option “actions harmful to the client owing to the work culture” entirely depends on the professionals’ perception of work culture. Nevertheless, it can be assumed that the majority of the reports pertain to the visible parts of organizational culture, as outlined in Schein’s model (Schein, 1984).

Work culture has a significant impact on both employees and clients. Organizational factors have been significantly associated with employees’ high-stress scores in social services (Antonopoulou et al., 2017). André et al. (2014) identified factors in a work culture that contribute to the quality of care in nursing homes. The possibilities for influencing the work conditions, leadership style, communication, and job satisfaction within an organization are connected to the work culture and can improve the quality of care (André et al., 2014). Positive work culture can lead to better outcomes for service users (Braithwaite et al., 2017). According to research by Jones and Kelly (2014), work culture can suppress openness and normalize suboptimal care over time. The reason why suboptimal care can persist without being reported is that individuals became habituated to the prevailing work culture and suboptimal care may be difficult to question within an organization (Jones & Kelly, 2014). According to Glisson (2015), effective organizational cultures establish expectations for the service provider that aim to achieve optimal client outcomes based on current information.

Braithwaite et al. (2017) systematic review of healthcare contexts highlights the fact that there is significantly more research related to culture compared to research on the correlation between organizational and workplace culture and patient outcomes. Similarly, Goering’s (2018) systematic review reveals the same lack of studies regarding the connection between culture and outcomes in child welfare. This study aims to provide insight into harmful work culture and its effects on social services clients from the perspectives of social services professionals.

Social service professionals have an ethical obligation to prevent clients from being repeatedly harmed by the same mistakes or risks (Sicora, 2018). Concealing mistakes and risks could potentially result in greater harm or increased exposure to risk. Therefore, highlighting a single risk may be significant (Sicora, 2017). While it is mandatory for social service professionals in Finland to report any observed risks, not all risks have been reported (Koskiniemi et al., 2023). The Social Welfare Act (1301/2014) prohibits punishing employees for reporting observed risks as per the reporting obligation. However, a culture of blame can discourage professionals from fulfilling their responsibilities toward social services clients (Sicora, 2018). Employees are more likely to discuss difficult issues when they have a trusting relationship with their managers (Ruch et al., 2014).

Various reporting systems allow for the collection of information on mistakes and risks, which makes it technically feasible to gain knowledge from them (Sicora, 2018). According to Macrae (2016), reporting systems should not only function as data collection and analysis mechanisms but also form part of a learning process. Therefore, how reports are managed is a crucial aspect of the reporting process, and managers’ approaches to the reports reflects the significance of reporting to employees. Collaborating with professionals in processing reports allows for highlighting the actions taken and shared learning (Macrae, 2016). For example, team meetings can be useful for shared learning (Jones & Kelly, 2014). This study offers novel insights into the actions taken by managers in Finnish social services following the reporting of risks and threats, based on professionals’ perceptions of events related to harmful work culture.

The SPro system addresses social services professionals’ reporting obligation as stated in the Social Welfare Act (1301/2014). While the system does not allow clients or relatives to report risks or threats, a reporting system specifically for clients is anticipated to be developed in the coming years (The Ministry of Social Affairs and Health, 2022). Incidents involving threats to employees are reported to a separate system. The SPro system is currently utilized in 615 social service units in Helsinki and is the first of two electronic reporting tools for fulfilling reporting obligations in Finnish social services, to the best of our knowledge. A comprehensive national reporting system is not utilized in Finland, and the SPro system is only employed in selected regions. The SPro reporting system is not anonymous. Reporters classify observed events as either risks or threats, selecting the type of reports from six predefined options, of which “actions harmful to the client owing to the work culture” is one option. Events that compromise client safety and fail to fulfill the client’s legal rights under the Social Welfare Act (1301/2014) are reportable harmful actions.

Following reporting, the handler, often the unit’s manager, who is responsible for managing the report, may supplement the report with a description of the measures to be implemented. Additionally, the handler selects from one of four predefined options (no harm, mild, moderate, serious) to describe the event’s impact on the client. The handler´s decision of the event’s consequence for the client is based on the report made by the social service professional. Professionals are trained to describe events as detailed as possible, including possible consequences for clients. However, handlers document consequences using predefined options; any criteria for that are not provided by the SPro system or employer.

Methods

Sample

The reports concerning harmful actions to clients due to work culture based on social service professionals’ perspective (n = 97) were collected from all the reports (n = 1,433) made to the SPro system between October 11, 2016, and December 31, 2020.

Data collection

Permission to use the data from the SPro system was obtained from the city of Helsinki, where the SPro system was originally developed and is continuously being improved in cooperation with Awanic (Ltd), an IT company that serves as the system’s administrator (Awanic, 2022). The data for the analysis were provided by Awanic and assigned to the research group in Excel format in January 2022.

Data analysis

The dataset comprised both structured and unstructured text. First, the data were scrutinized and read multiple times. One duplicate report and one report of a different type of observation (client abuse) were removed. Second, the structured data were analyzed using R software (version 3.6.1) and described using frequencies and percentages.

The original dataset comprised 17 variables, which included a structured section containing the registration number, date of the report, reporter’s unit, the unit covered by the report, the reporter’s occupational group, date and time of the event, risk or threat of risk, of the week of the event, type of observation, consequences of the event for the client, measures to prevent recurrence of the event, and a detailed proposal of measures to avoid a recurrence of the event.

The unstructured data describing the events and managers’ actions after reporting were analyzed using inductive content analysis (Bengtsson, 2016) and quantification. First, the event descriptions were read thoroughly multiple times. Second, meaning units or parts of the text were identified from the data. Third, the specified units were simplified. From the simplified meanings, units were identified as codes corresponding to the research question. Fourth, the codes were grouped into generic categories and main categories.

When the social service professional observed risks or threats and provided suggestions to prevent recurrence of the event in the report, the report was sent to the unit’s manager. Managers then recorded descriptions of the implemented measures in their reports. Out of 95 reports, ten did not include a description of the measured implemented. In seven reports, managers commented on the event without describing any action, and in three reports, the managers stated that the measures were unnecessary. The manager transferred one of these reports to the patient safety incident reporting system. The remaining 74 reports included descriptions of the implemented measures (n = 110) and were analyzed using inductive content analysis and quantification, as described above. The measures were categorized into main categories and then connected to the main categories of the descriptions of each identified event.

Ethics

The city of Helsinki provided a license for this study, including the use of data from the SPro system in 2021. According to the Act on the Secondary Use of Health and Social Data (552/2019), ethical assessment is not required for the use of registered social care data. The SPro reports contained the names of the reporters, which were removed before the data was assigned to the researchers. Although some names were mentioned in the unstructured text descriptions, these were also removed during the analysis.

Results

Most reports were submitted by social workers (n = 38, 40.4%), and most frequently reported events caused mild harm to the client (n = 26, 27.7%; Table 1). In over one-fifth of the reports, handlers, who are often the units’ managers, did not record the severity of the consequences for the client (n = 21, 22.3%).

Table 1. Characteristics of the reports.

	f	%
The reporters’ occupations
Social workers	38	40.4
Other	27	28.7
Social advisors or other advisors of social work	14	14.9
Practical nurses or care workers	8	8.5
Registered nurses	5	5.3
Unknown	2	2.2
Public health nurses, rehabilitation and therapy staff, physicians, students, and trainees	0	0
Total	95	100.0
Professional’s perception of the severity of the actions harmful to the client due to the work culture
Risk	82	87.2
Threat of risk	12	12.8
Total	95	100.0
Handler’s (often the unit manager) perception of the consequence for the client based on the report
Mild harm	26	27.7
Unknown	21	22.3
No harm	20	21.3
Moderate harm	17	18.1
Serious harm	10	10.6
Total	95	100.0

Actions harmful to the client due to the work culture from professionals’ perspective

Actions harmful to the client due to the work culture reported by social care professionals were categorized into generic categories (n = 21) and into main categories (n = 5) (Table 2). The main categories were:

Table 2. The main and generic categories of event descriptions.

Main categories (n = 5)	Generic categories (n = 21)
1. Problems in the implementation of the service or treatment (n = 29)	1. Problems related to rules and supervision (n = 7) 2. The continuity of care/support does not materialize (n = 6) 3. Lack of consideration of the client’s needs (n = 6) 4. Problems related to the assessments and decisions regarding care (n = 4) 5. Problems related to the COVID-19 pandemic (n = 3) 6. The client’s problem is not responded to despite the contact (n = 3)
2. Problems with the flow of information (n = 28)	1. Challenges in communication between the units (n = 8) 2. Challenges between the client or relative and unit (n = 6) 3. Problems with the flow of information related to the organization of work tasks (n = 6) 4. Insufficient recording (n = 6) 5. Challenges between the unit professionals (n = 2)
3. Problems in cooperation (n = 22)	1. The ambiguity of the division of labor (n = 10) 2. Planning for the service/care is not implemented in cooperation (n = 8) 3. Implementing the client’s service/treatment against the joint negotiations (n = 4)
4. Lack of resources (n = 19)	1. Insufficient human resources (n = 8) 2. Lack of foster homes (n = 4) 3. Lack of emergency housing service, housing services, and rehabilitative units (n = 4) 4. Insufficient implementation (n = 3)
5. Problems related to an individual’s action (n = 7)	1. Communication with the client/relative (n = 3) 2. Lack of carefulness (n = 3) 3. Failure to comply with the rules/instructions (n = 1)

1) problems in the implementation of the service/treatment (n = 29),

2) problems with the flow of information (n = 28),

3) problems in cooperation (n = 22),

4) lack of resources (n = 19), and

5) problems related to an individual’s action (n = 7).

Problems in the implementation of the service or treatment

Problems in the implementation of the service or treatment form six generic categories.

1. Problems related to rules and supervision (n = 7). The clients’ rules were not congruent, the clients were punished for misbehavior and excessive restrictive measures in a restrictive situation. The reports described how professionals’ control of the units did not work: the department had been left unsupervised, the client obtained access to another client’s medicines, and cases of conflicts between the clients were not addressed.

The advisors left the unit completely unsupervised and held the report on the first floor of the building, where the clients had no access due to electrical locks. [Report 282]

2. Continuity of care or support did not materialize (n = 6). Problems related to the continuity of care or support concerned with the nurse system, the stability of workers, lack of support during rehabilitation, issues in the change of the client relationship from one unit to another, and insufficient restriction measures for the client enable the client to escape from treatment.

The client and the client’s mother had to wait for an unacceptably long starting meeting in a situation where the need for services had been established. [Report 988]

The rehabilitee did not know who their named nurse was. [Report 616]

3. Lack of consideration for client needs (n = 6). Client needs were ignored when trade orders and the schedule of client visits were planned. In addition, clients’ nutritional plans, care plans, addiction, and requirements for financial support were not considered.

The patient was assisted in bed to sleep at 4:58 pm. Night home care visited at 5:40 in the morning. The client was in bed for over 12 h. [Report 879]

4. Problems related to assessments and decisions regarding care (n = 4). In some cases, the clients had to wait for assessment visits and care decisions for multiple months.

Now, the client is in the hospital, but they are discharging the client who needs 2–3 nurses’ help, resists care, and is aggressive. Therefore, care decisions should be made faster. [Report 439]

5. Problems related to the COVID-19 pandemic (n = 3). The data included reports on the COVID-19 pandemic. These reports described unclear instructions for working during the pandemic and short safe distances in the units, which affected the client’s possibility of visiting the units.

The family has not been offered adequate support for crisis services appealing to the pandemic. [Report 1220]

6. The client’s problems did not respond despite contact (n = 3). The clients’ issues were urgent and non-urgent, and in many of the reports, the client contacted the suitable unit.

The mother was sent away from the health center and was not allowed to meet a physician or nurse at either health center in an acute situation. [Report 506]

Problems with the flow of information

Problems with the flow of information consisted of five generic categories.

1. Challenges in communication between units (n = 8). Between the units, notifications (notices of need for social care, child welfare notifications) were transferred with delay from one unit to another, changes in the client’s care and discharge were not transmitted from the hospital to the unit, and there were problems with the flow of information related to the change in the client relationship from one unit to another.

Discharge from the unit has not been informed of home care, even though homecare should be visited twice a day. In addition, the patients were not informed of the chances of medication and other agreed treatments. An evening visit onSaturday was not implemented. [Report 489]

2. Challenges between the client or relative and unit (n = 6). The client or relative did not always know their responsibility to contact the unit, relatives were not informed about the client’s situation, an interpreter was not used, and the relative did not reach out to the service.

The foster home has repeatedly asked to use an interpreter in communication with the parent, who does not speak Finnish. Based on the social worker’s information, an interpreter was used once during the year. [Report 1225]

3. Problems with the flow of information related to the organization of work tasks (n = 6) were often connected to the unit that distributes work tasks. The problem was that information about the need for additional client visits was not transmitted to the unit that distributed work tasks, the printed list did not include all client visits of the work shift, and there were mistakes in the manual insertion of the client visit to the electrical system. There was ambiguity regarding how professionals’ contact requests were handled during absences.

The evening visit was not added to the system manually; therefore, the visit was left undone. [Report 874]

4. Insufficient recordings (n = 6). Recording the actions and situations of clients by professionals was either insufficient or missing. Moreover, there were omissions in recording client relationships, clients in the treatment queue, and child welfare notifications.

The event was not recorded by the security service. The evening home care nurse did not record the event at all, even though the nurse had received information about the event. The nurse who answered the emergency phone inadequately documented the event. [Report 1358]

5. Challenges between the professionals of the unit (n = 2) were linked to reaching substitutes during work shifts.

An agency contract worker has a general identifier for the system; that is, their contacts are not visible in the system’s contacts. – A nurse did not know/find the agency contract worker’s phone number. [Report 982]

Problems in cooperation

The problems of cooperation form three generic categories. These problems arose in the units’ internal actions and cooperation between the units and entities outside social care. However, most problems were in cooperation between the social service units.

1. The ambiguity of the division of labor (n = 10) appeared as ambiguities between employees within the unit and as the transfer of the client’s matter between different units.

Omission of care has occurred because there is no clear process description for cases of staff illnesses. [Report 368]

2. Planning for the service/care was not implemented in cooperation (n = 8) when the clients or professionals were not prepared for the planning meetings, or all units or cooperative entities outside social services were not considered.

The personal coach supported the client on arrival for the treatment times, but they were not taken from the lobby to the meeting once. [Report 182]

3. Implementing the client’s service/treatment against the joint negotiations (n = 4) occurred when the client’s service/care was implemented/changed contrary to what was agreed in the joint negotiations.

Home help services visited the family twice a week against the agreement. [Report 917]

Lack of resources

Lack of resources considered four generic categories.

1. Insufficient human resources (n = 8). Human resources were insufficient for additional work tasks, but resources were insufficient to start new client home visits on time. It was impossible to obtain a doctor-to-home visit other than home care clients. Insufficient human resources also included skill shortages: all professionals in the work shift were substitutes, or knowledge of medical treatment was insufficient in the work shift.

The nurse who received the call informed the work task controller of a new client. The work task controller said that work lists are so crowded on the weekend that new clients cannot take care of within working hours. [Report 283]

There was insufficient knowledge about medication treatment during the shift. For example, no one on the shift knew how to administer medication through a tube. [Report 1318]

2. Lack of foster homes (n = 4) appeared as a lack of long- and short-term foster homes. The foster home may have been far away from the home and other care contacts, or the client had to give up their room to the new client before discharging owing to a lack of rooms.

The closest foster home was found at [place]. It is situated over 100 km from the family and office of child welfare. [Report 209]

3. Lack of emergency housing services, housing services and rehabilitative units (n = 4) caused situations where, for example, homeless people could not fit into temporary accommodation. Sheltered homes took only a certain number of clients for substitution treatment.

Three clients stayed out because they arrived at the service center, which was full between 12 and 3 AM. [Report 1284]

4. Insufficient implements (n = 3). Professionals did not have sufficient implements to perform work tasks.

There is no shower trolley that would be possible to use with clients in poor condition to wash in the sauna downstairs humanly and without causing additional pain. [Report 45]

Problems related to an individual’s action

Problems related to an individual’s action form three generic categories.

1. Lack of care (n = 3),

2. Professionals’ unsuitable communication with the client/relative (n = 3), and

3. Failure to comply with rules (n = 1).

The advisor gave the financial support document to another advisor, and the shop cashier became aware of this confidential document. [Report 1192]

[Place´s] advisor started to oppose the placement of the boy to [place] in front of the mother when the social worker was meeting the boy in [place]. [Report 1436]

Employers’ actions after reporting

In 74 reports, the managers described the realized measures (n = 110) after reporting. These measures were divided into 16 main categories. Most commonly, employers’ first step taken was to discuss the reported event within the unit (n = 30). “Discuss within the unit” was the most frequent action taken in all problem categories described above, except in “problems in cooperation” (Table 3).

Table 3. The actions taken by managers following reporting.

Realized measures	Main categories of event descriptions
	Problems in the implementation of the service or treatment (n = 29)	Problems with the flow of information (n = 28)	Problems in cooperation (n = 22)	Lack of resources (n = 19)	Problems related to an individual’s action (n = 7)	Total
Discussed in the unit	12	8	3	4	3	30
Discussed with individual employee	3	2	4	1	2	12
Made/updated instructions	5	4	2	1	0	12
Requested the written explanation	4	3	1	1	2	11
Notified the management	3	1	2	3	0	9
Prepared notice for information to another unit	1	1	2	2	0	6
Planned the client’s care/service again	2	1	3	0	0	6
Discussed with those concerned	0	4	1	0	0	5
Discussed with another unit	1	1	2	0	0	4
Cooperation between the units was strengthened	1	1	1	0	0	3
Discussed with the physician	0	1	2	0	0	3
Working conditions were changed	2	1	0	0	0	3
Discussed with the client/relative	1	1	0	0	0	2
Requested the employee to revise records	0	1	1	0	0	2
Took the event to police investigation	1	0	0	0	0	1
Organized additional training	1	0	0	0	0	1
Total	37	30	24	12	7	110

In most cases, the reports were handled through discussions in the unit, for example, in team meetings. The reports that the managers wanted to discuss within the unit were often related to problems in the implementation of service/treatment (n = 12) and the flow of information (n = 10). The introductions were made or updated orally or in writing. The client’s care or service was planned again, agreeing to treatment consultation, follow-up period, physician assessment visit, or home visit for the client.

We agreed that the home care physician makes an assessment visit. [Report 265]

Home care makes a two-week follow-up. [Report 265]

Cooperation between the units was strengthened by maintaining a collaborative meeting or clarifying the communication between the units.

We need to ensure that both adult social work and child welfare are aware of the contact channels between employees. [Report 867]

Managers changed their working conditions to offload the workload of employees. In addition, managers facilitate working conditions by procuring suitable implements.

Discussion

The objective of this study was to describe events observed and reported by social service professionals. The study aimed to determine which events, related to work culture, these professionals deemed harmful to social services clients. In addition, primary measures taken by managers to eliminate the risks and threats mentioned in the reports were described. Reports concerning harmful work culture were frequently associated with difficulties in service or treatment implementation and information flow. Typically, the first step taken by managers was to discuss the reported events within the unit.

Between 2016 and 2020, social services professionals reported 95 events categorized as “actions harmful to the client owing to the work culture.” These reports were classified into five main categories, with communication being closely linked to three of them. Problems in communication affected problems in cooperation, implementation of the service or treatment, and the flow of information. Communication is one of the dimensions of the relationship between workplace culture and quality of care (André et al., 2014) and increases positive outcomes for services (André et al., 2014; Braithwaite et al., 2017) and the meaning of successful communication for clients is easy to understand. According to professionals, multi-professional work particularly requires good communication (Ambrose-Miller & Ashcroft, 2016). In this study, these problems appear in planning and implementation of services and unclear divisions of labor. Improving collaboration and information flow could, therefore, improve service quality.

According to André et al. (2014), work culture and quality of care can be enhanced by improving working conditions. While it is impossible to determine the exact number of incidents where workload has been a contributing factor, reports on risks associated with social services have cited workload as a significant issue. In response to these reports, managers have categorized them as requiring action to be taken by discussion within the relevant unit. A closer inspection of the discussion areas revealed that the managers have either taken the necessary steps or are actively working toward reducing the workload.

Overall, to the SPro-system, professionals have reported a shortage of resources as being a factor that affects the quality of social services provided to their clients. Based on the reports, professionals do not always have the necessary means or conditions to perform their tasks in the best of their abilities. Professionals reported a lack of beds in different social services. Stevens et al. (2021) found that a lack of hospital beds has been identified as a factor that can impact the willingness of social workers to work as mental health professionals.

Social care services all over the world faced the same crisis from the beginning of 2020, even though the pandemic’s impacts varied. The COVID-19 pandemic forced human service organizations to change their services and impacted resources (Ma & Beaton, 2023). Ma and Beaton’s (2023) recent study shows that nonprofit human service organizations’ leaders have concerns related to the ability to provide services for all in need of help in the future. Not only did the beginning of the pandemic cause changes in the field of social care, but also a downward trend of the pandemic forced human service organizations to change because resources are changing (Ma & Beaton, 2023). The findings of this study are located mainly at the time before the COVID-19 pandemic, but it would be important to examine how the effects of the pandemic are visible in employees’ reports. Only few of the reports were straight linked to the pandemic in this study.

Changes forced from the outside may have led to less consideration of the social service professionals’ point of view in implementing service entities. The results of this study indicate what kind of perspectives organizations should consider when thinking about the working environment of social service professionals as well as the realization of clients’ rights. Although the reports specifically focus on the consequences of the work culture perceived as harmful to clients from the perspective of the social service professionals, the professionals have inevitably raised issues that challenge them as professionals in their daily work. Only highlighting issues is not enough; concrete utilization of professionals’ observations is needed.

Social care professionals play a crucial role in client safety. As specialists, they work closely with clients and may be the only people observing the risks and threats inherent in the implementation of a client’s social welfare. These professionals have a legal duty to uphold clients’ rights, and an ethical obligation to provide quality services in their specific capacities. Previous research by Koskiniemi et al. (2023) shows that while social service professionals are obligated by law to report all observed risks, risks often remain unreported. Currently, the SPro system is used by 615 units in the city of Helsinki (Koskiniemi et al., 2023). However, in data from a 5-year period, less than 100 reports filed were related to harmful work culture. Underreporting may occur because reports rarely lead to any meaningful actions or changes within a unit (Liukka et al., 2019), staff members are unaware of the steps taken in response to their reports (Macrae, 2016), or because not all professionals recognize reporting as a necessary part of their work.

Managers are legally responsible for initiating measures to eliminate observed risks (The Social Welfare Act, 1301/2014). The SPro system and HaiPro patient safety incident reporting system in healthcare are similarly structured. However, HaiPro system has different requirements related to reporting the actions taken by managers compared to the SPro system. In a study by Liukka et al. (2019), it was found that managers’ recommendations were included in only 4.1% of patient safety incident reports annually. Managers’ perspectives were absent in only 10.5% of the reports analyzed in this study. The planned actions must be implemented, and their factual implementation must be reported in Finnish social care. However, in this particular sample, over half of the managers intended to address the reports by discussing with various stakeholders. Reports rarely provided specific details about concrete changes to the courses of action or instructions for staff. Reporting may therefore seem futile to professionals if they do not see any actions (Liukka et al., 2019) and annual statistical reports fail to demonstrate concrete actions.

A lack of a comprehensive reporting system makes it impossible to compare the state of client safety nationally in social care settings. To the best of our knowledge, no other nation has a similar reporting system, such as the SPro. As a result, it is not possible to utilize data from the SPro system optimally since there is no basis for comparison. A national client safety reporting system that is similarly comprehensive would make it easier to monitor the development of client safety and support its improvement. Developing a reporting process and encouraging managers to inform staff about actions taken in response to submitted risk-of-harm cases could increase reporting rates. The SPro system is a crucial tool for collecting information related to the client’s rights, work conditions, and social services management. However, the standardized classification categories used in the SPro system may conceal vital information. A more in-depth inspection and analysis of the unstructured data would therefore be valuable.

Strengths and limitations

The data used in this study were self-reported by professionals and social services managers and were thus initially collected for research purposes, resulting in some limitations to its use. A significant limitation of using pre-collected information as data for research is the absence of information on data quality (Thygesen & Ersbøll, 2014). As previously stated, defining the concept of work culture is a challenge, and professionals themselves have categorized their reports as work culture-related. The reports analyzed in this study were drawn exclusively from one city, resulting in a relatively low total number of reports despite collecting data for over four years. Nonetheless, this study shed some light on the adverse impact of work culture on clients in social services from the perspective of professionals, as well as the measures managers implemented to address these issues.

Conclusions

This study offers valuable insights from the professionals’ perspectives into harmful practices that may jeopardize client safety in social care due to work culture, shedding light on an under-researched area. Though the data used is from Finnish social care, the data covers a wide range of social service entities. This study provides insight into work culture-related issues such as the implementation of services, flow of information, and cooperation, which should be improved for the clients’ best. The safety culture determines client safety’s position in social services and social care, what kind of measures are initiated, and how they are successfully implemented. The way safety issues are treated at the workplace affects people’s actions and the workplace’s safety culture. The study also outlines the measures adopted by social service managers to mitigate the reported risks, which primarily entailed unit-level discussions and a few concrete changes in operational procedures. The observed risks reflect the state of clients’ safety. To understand the situation comprehensively, a comparable national reporting system must be established, and clients’ perspectives must be considered. Further research is needed to investigate the adverse effects of work culture on clients, and it is crucial to examine the effectiveness of measures aimed at eliminating identified risks.

Acknowledgments

The authors thank the Finnish Nursing Education Foundation. We also thank the city of Helsinki for the research ideas and the possibility of using the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Finnish Nursing Education Foundation.