At a crossroads? Key challenges and future opportunities for patient involvement in patient safety

O’Hara, Jane; Lawton, Rebecca

doi:10.1136/bmjqs-2016-005476

Cited by 65 publications

(66 citation statements)

References 19 publications

(22 reference statements)

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“…There are current improvement drives towards greater ‘patient activation’ in relation to facilitating involvement and self‐management, but these are at risk of labelling patients by trait and fail to acknowledge the dynamic nature of involvement that fluctuates in response to various compelling contextual factors. The ultimate aim of supporting involvement would be to create a space that enables patients to shift from passive information‐acting to actively voicing their concerns in such a way that does not fundamentally seek to change their way of being and that effectively meets people ‘on their own turf’ …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

How older people enact care involvement during transition from hospital to home: A systematic review and model

Murray

Hardicre

Birks

et al. 2019

Health Expectations

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BackgroundCurrent models of patient‐enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to ‘reach‐in’ to complex health‐care systems.ObjectiveTo develop a dynamic and interactional model of patient‐enacted involvement in care.Search strategyElectronic search strategy run in five databases and adapted to run in an Internet search engine supplemented with searching of reference lists and forward citations.Inclusion criteriaQualitative empirical published reports of older people's experiences of care transitions from hospital to home.Data extraction and synthesisReported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding leads to the development of a new framework and thereafter a model representing changing states of involvement.Main resultsPatients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health‐care professionals as they attempt to resolve health‐ and well‐being‐related goals. ‘Non‐involvement’, ‘information‐acting’, ‘challenging and chasing’ and ‘autonomous‐acting’ were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion leads patients to act autonomously, creating the potential to cause harm.Discussion and conclusionThe model suggests that involvement is highly challenging for older people during care transitions. Going forward, interventions which seek to support patient involvement should attempt to address the dynamic states of involvement and their mediating factors.

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Section: Discussionmentioning

confidence: 99%

“…The ultimate aim of supporting involvement would be to create a space that enables patients to shift from passive information-acting to actively voicing their concerns in such a way that does not fundamentally seek to change their way of being and that effectively meets people 'on their own turf'. 55…”

Section: Implications For Research and Practicementioning

confidence: 99%

How older people enact care involvement during transition from hospital to home: A systematic review and model

Murray

Hardicre

Birks

et al. 2019

Health Expectations

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“…Speaking up about confusing medications or care instructions is not the same as recognising and communicating about patient deterioration, calling out a perceived medical error or speaking up about disrespectful treatment—each distinct problems, with different barriers and motivators 21. The proportion of patients (70%) in Fisher and colleagues’16 study who always felt comfortable speaking up was unexpectedly high, standing in contrast to other reports 14 21 22.…”

mentioning

confidence: 84%

Every patient should be enabled to stop the line

Bell

Martínez

2018

BMJ Qual Saf

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“…The difficulties of getting the right staff together for these meetings and “finding time to think about safety” were emphasized, and there was a sense that when introducing a new intervention, consideration needs to be given to how the intervention ties in with other initiatives, and other sources of patient feedback available to wards. These findings speak to on‐going debates around the use and usefulness of patient feedback for service improvement, in particular the capacity for staff to make sense of the different forms of patient feedback . Finally, staff were supportive of the potential for involving hospital volunteers in the action planning meetings, recognizing the benefits this different perspective could bring.…”

Section: Discussionmentioning

confidence: 75%

A qualitative formative evaluation of a patient‐centred patient safety intervention delivered in collaboration with hospital volunteers

Louch

O’Hara

Mohammed

2017

Health Expectations

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BackgroundEvidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time.ObjectiveTo undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders.DesignA qualitative evaluation design was adopted across two acute NHS trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n=15), voluntary services and patient experience staff (n=3) and semi‐structured interviews with ward staff (n=5). Data were interpreted using framework analysis.ResultsAll stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase.ConclusionAlthough there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement.

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At a crossroads? Key challenges and future opportunities for patient involvement in patient safety

Cited by 65 publications

References 19 publications

How older people enact care involvement during transition from hospital to home: A systematic review and model

How older people enact care involvement during transition from hospital to home: A systematic review and model

Every patient should be enabled to stop the line

A qualitative formative evaluation of a patient‐centred patient safety intervention delivered in collaboration with hospital volunteers

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