Passing Laws is Not Enough to Change Staff Practice: the Case of Legally Mandated "incident" Reporting in Sweden

Background It is mandatory for staff in Swedish community services for people with intellectual disabilities to report incidents of error or malpractice. Aim The aim is to study if incident reports contribute to developing quality in services for people with intellectual disabilities who present with challenging behaviours. Method 159 reports on incidents from group homes and daily activities services were accessed and analysed using narrative thematic analysis. Results Most reports concerned altercations between service users. Analysis focused mainly on the immediate incident and attributes of service users. Amendments were not (obviously) aligned with causes, and neither sufficiently addressed structural shortcomings. Restrictive measures were described, but changes in practices were not mentioned. Reports including Self-injurious behaviour (SIB) were conspicuously absent. Conclusion Reports are handled in a seemingly perfunctory manner, without any development. Quality development relying on staff reports and front-line managers' investigations requires support based on values rather than on the legal framework.