Observed Risks of Client Safety by Social Care Professionals in Finland

Trend Analysis for 2016-2020





social care, risk, client safety, incident reporting system


To promote client safety, Finland’s Social Welfare Act requires social services employees to notify superiors of the observed risks in implementing clients’ social welfare. This study provides the first retrospective trend analysis of reports from a care reporting system (SPro-system) in Finland. Reports (n=1,433) were made by social work employees in the city of Helsinki in Finland, from October 2016 to December 2020. The statistical analysis focused on investigating trends in the reports. Most commonly reporters were practical nurses or other care workers (31.0%, n=444) or social advisors or other advisors of social work (23%, n=329). The total of observed risks or threats increased annually, except in 2019. The content of reports mainly related to a lack of realization of the status and rights of clients (32.5%, n=475) with the consequence for clients being moderate harm (28.3%, n=406). Information and discussion about client safety events (55.1%, n=860) were perceived as the most important ways to prevent the recurrence of such incidences. More empirical research is needed on client safety from the social work perspective. Risks in social care are diverse, but professionals’ observations may help to prevent them. Thus, reporting practices relating to client safety risks should be strongly encouraged, if not mandated.


Attar-Schwartz, S. (2008). Emotional, behavioral and social problems among Israeli children in residential care: A multi-level analysis. Children and Youth Services Review, 30(2), 229-248. https://doi.org/10.1016/j.childyouth.2007.09.009

Awanic. (2022). Products and services. https://awanic.fi/eng/products-and-services/#haipro

Björne, Deveau, R., & Nylander, L. (2021). Passing laws is not enough to change staff practice: The case of legally mandated “incident” reporting in Sweden. Journal of Intellectual & Developmental Disability, 46(2), 186-196. https://doi.org/10.3109/13668250.2021.1873751

Churruca, K., Ellis, L. A., Pomare, C., Hogden, A., Bierbaum, M., Long, J. C., Olekalns, A., & Braithwaite, J. (2021). Dimensions of safety culture: A systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open, 11(7), 1-13. https://doi.org/10.1136/bmjopen-2020-043982

Constitution of Finland. 11.6.1999/731. https://www.finlex.fi/fi/laki/kaannokset/1999/en19990731.pdf

Enosh, Tzafrir, S. S., & Gur, A. (2013). Client aggression toward social workers and social services in Israel - A qualitative analysis. Journal of Interpersonal Violence, 28(6), 1123-1142. https://doi.org/10.1177/0886260512468230

Evans, T., Hardy, M., & Shaw, I. (2010). Evidence and knowledge for practice. Polity.

Finnish Institute for Health and Welfare. (2020). Social protection expenditure and financing in 2020. https://thl.fi/en/web/thlfi-en/statistics-and-data/statistics-by-topic/social-and- health-care-resources/social-protection-expenditure-and-financing

Finnish National Board on Research Integrity TENK. (2019). The ethical principles of research with human participants and ethical review in the human sciences in Finland. Finnish National Board on Research Integrity TENK publications 3/2019. https://tenk.fi/sites/default/files/2021-1/Ethical_review_in_human_sciences_2020.pdf

Fook, J., Ryan, M., & Hawkins, L. (2000). Professional expertise: Practice, theory and education for working in uncertainty. Whiting & Birch Ltd.

Gambrill, E. (2017). Avoidable ignorance and the ethics of risk in child welfare. Journal of Social Work Practice, 31(4), 379-393. https://doi.org/10.1080/02650533.2017.1394824

Gibson, M. (2014). Social worker shame in child and family social work: Inadequacy, failure, and the struggle to practise humanely. Journal of Social Work Practice, 28(4), 417-431. https://doi.org/10.1080/02650533.2014.913237

Gil, A. P., & Capelas, M. L. (2022). Elder abuse and neglect in nursing homes as a reciprocal process: The view from the perspective of care workers. Journal of Adult Protection, 24(1), 22-42. https://doi.org/10.1108/JAP-06-2021-0021

Härkänen M., Murrells T., Rafferty A. M., Franklin B. D., & Vehviläinen-Julkunen, K. (2020). Factors contributing to reported medication administration incidents in patients’ homes - A text mining analysis. Journal of Advanced Nursing 76(12), 3573-3583. https://doi.org/10.1111/jan.14532

Ilmarinen, K., Aalto, A-M., & Muuri, A. (2016). Sosiaalipalvelut väestön ja asiakkaiden arvioimana. Suomen sosiaalinen tila 1/2016. Finnish institute for health and welfare. https://urn.fi/URN:ISBN:978-952-302-674-2

Johannesen, M., & LoGuidice, D. (2013). Elder abuse: A systematic review of risk factors in community-dwelling elder. Age and Ageing, 42(3), 292-298. https://doi.org/10.1093/ageing/afs195

Karlsson, N. D., Markkanen, P. K., Kriebel, D., Gore, R. J., Galligan, C. J., Sama, S. R., & Quinn, M. M. (2019). Home care aides’ experiences of verbal abuse: A survey of characteristics and risk factors. Occupational and Environmental Medicine (London, England), 76(7), 448-454. https://doi.org/10.1136/oemed-2018-105604

Kinnunen-Luovi, K., Saarnio, R., & Isola, A. (2014). Safety incidents involving confused and forgetful older patients in a specialised care setting - analysis of the safety incidents reported to the HaiPro reporting system. Journal of Clinical Nursing, 23(17-18), 2442-2450. https://doi.org/10.1111/jocn.12364

Kivimäki, T., Stolt, M., Katajisto, J., Charalambous, A., & Suhonen, R. (2022). National registry- based data of adverse events in Finnish long-term professional homecare in 2009- 2019. Journal of Clinical Nursing, 00, 1-10. https://doi.org/10.1111/jocn.16312

Liegghio, M., & Caragata, L. (2016). Why are you talking to me like I`m stupid?: The micro- aggressions committed within the social welfare system against lone mothers. Affilia, 31(1), 7-23. https://doi.org/10.1177/0886109915592667

Liukka, M., Hupli, M., & Turunen, H. (2019). Problems with incident reporting: Reports lead rarely to recommendations. Journal of Clinical Nursing, 28(9-10), 1607-1613. https://doi.org/10.1111/jocn.14765

Lo, C. K.-M., Ho, F. K.-W., Chan, K. L., Wong, W. H.-S., Wong, R. S.-M., Chow, C.-B., Tsang, A. M.-C., Tso, W. W.-Y., & Ip, P. (2018). Linking healthcare and social service databases to study the epidemiology of child maltreatment and associated health problems: Hong Kong's experience. The Journal of Pediatrics, 202, 291-299. https://doi.org/10.1016/j.jpeds.2018.06.033

Macrae, C. (2015). The problem with incident reporting. BMJ Quality & Safety, 25(2), 71-75. https://doi.org/10.1136/bmjqs-2015-004732

Ministry of Social Affairs and Health. (2022a). The client and patient safety strategy and implementation plan 2022-2026. http://urn.fi/URN:ISBN:978-952-00-8464-6

Ministry of Social Affairs and Health. (2022b). Social and health services. https://stm.fi/en/social-and-health-services

Myhre, J., Saga, S., Malmedal, W., Ostaszkiewicz, J., & Nakrem, S. (2020). Elder abuse and neglect: An overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect. BMC Health Services Research, 20(1), 1-14. https://doi.org/10.1186/s12913-020-5047-4

National Association of Social Workers. (2021). Highlighted revision to the code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Highlighted-Revisions- to-the-Code-of-Ethics

O’Donovan, R., Ward, M., De Brún, A., & McAuliffe, E. (2019). Safety culture in health care teams: A narrative review of the literature. Journal of Nursing Management, 27(5), 871-883. https://doi.org/10.1111/jonm.12740

Pulkki, J., Jylhä, M., Forma, L., Aaltonen, M., Raitanen, J., & Rissanen, P. (2015). Long-term care use among old people in their last 2 years of life: variations across Finland. Health & Social Care in the Community, 24(4), 439-449. https://doi.org/10.1111/hsc.12224

Radey, M., & Wilke, D. J. (2021). Client-perpetrated violence among frontline child welfare workers. Journal of Interpersonal Violence, 36(11-12), NP6260-NP6280. https://doi.org/10.1177/0886260518812792

Sicora, A. (2017). Reflective practice, risk and mistakes in social work. Journal of Social Work Practice, 31(4), 491-502. https://doi.org/10.1080/02650533.2017.1394823

Sicora, A. (2018). Learning from mistakes in social work. European Journal of Social Work, 21(5), 684-696. https://doi.org/10.1080/13691457.2017.1320980

Social Welfare Act, 5:48.2-4 §, 30.12.2014/1301. https://finlex.fi/fi/laki/kaannokset/1982/en19820710_20140491.pdf

Status and Rights of Social Welfare Clients. 1.1.2001/812. https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/70035/Es200101eng.pdf

Stroebaek, P. S., & Korczynski, M. (2018). Client abuse to public welfare workers: Theoretical framework and critical incident case study. Sociology, 52(4), 762-777. https://doi.org/10.1177/0038038516672626

Tammelin, M., & Mänttäri-van der Kuip, M. (2022). Policy alienation in frontline social work: A study of social workers’ responses to a major anticipated social and health care reform in Finland. Ethics and Social Welfare, 16(1), 19-35. https://doi.org/10.1080/17496535.2021.1977836

Tiitinen, L., & Silén, M. (2016). Sosiaalialan epäkohdat ja niiden käsittely -kyselyraportti. (Social care risks and how to deal with them - survey report). University of Lapland. https://www.luc.fi/loader.aspx?id=46137c9e-60d5-4576-9696-f78c06e5f8d9

Vaarama, M., Karvonen, S., Kestilä, L., Moisio, P., & Muuri, A. (Eds.) (2014). Suomalaisten hyvinvointi (The wellbeing among Finnish people). Institute for Health and Welfare. Juvenes Print - Suomen Yliopistopaino Oy.

Valkonen, T., Vihriälä, V., & Albæk, K. (2014). Nordic model: Challenged but capable of reform. Nordic Council Of Ministers. http://norden.diva-portal.org/smash/get/diva2:715939/FULLTEXT02.pdf

Välimäki, T., Mäki-Petäjä-Leinonen, A., & Vaismoradi, M. (2020). Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review. Journal of Advanced Nursing, 76(8), 1977-1987. https://doi.org.ezproxy.uef.fi:2443/10.1111/jan.14397

World Health Organization [WHO]. (2014). Global status report on violence prevention 2014. https://apps.who.int/iris/rest/bitstreams/649376/retrieve

WHO. (2015). World report on ageing and health. https://apps.who.int/iris/rest/bitstreams/835463/retrieve

WHO. (2020a). Addressing violence against children, women and older people during the Covid-19 pandemic: Key actions. https://apps.who.int/iris/rest/bitstreams/1282412/retrieve

WHO. (2020b). Patient safety incident reporting and learning systems: Technical report and guidance. https://apps.who.int/iris/rest/bitstreams/1303416/retrieve

Yan, E. (2014). Abuse of older persons with dementia by family caregivers: Results of a 6-month prospective study in Hong Kong. International Journal of Geriatric Psychiatry, 29(10), 1018-1027. https://doi-org.ezproxy.uef.fi:2443/10.1002/gps.4092

Yon, Y., Ramiro-Gonzalez, M., Mikton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: A systematic review and meta-analysis. European Journal of Public Health, 29(1), 58-67. https://doi.org/10.1093/eurpub/cky093