Do older patients' perceptions of safety highlight barriers that could make their care safer during organisational care transfers?

Abstract

BackgroundHealthcare is a series of complex, interwoven systems in which any discontinuities of care may affect the safety of patients, who have been reported to perceive safety differently to clinicians. This study aimed to explore patient perceptions of safety and identify how they can be used to construct additional barriers to reduce safety incidents within organisational care transfers, which are known to be high in risk.DesignAppreciative Inquiry (AI) methodology was used to develop semi-structured interviews, using the Discover and Dream processes of AI. Fourteen patients (four men, 10 women; average age 76.2 years) were purposively recruited from NHS community care teams, social care homes and private nursing homes based on their experience of going through organisational care transfers. Thematic analysis was used to highlight key themes, which participants verified.FindingsCommunication, responsiveness and avoidance of traditional safety risks were identified as being important for patients to feel safe. Communication and responsiveness were mapped onto the Swiss-Cheese model of safety, presenting two new barriers to safety incidents. Traditional risks and the role of trust are discussed in relation to patients feeling safe.ConclusionPerceptions of safety such as communication and responsiveness were similar to those found in previous studies. Mapping these perceptions onto the Swiss-Cheese model of safety identifies how further defences, barriers and safeguards can be constructed to make people feel safer by reinforcing communication and responsiveness. Traditional risks are widely published, but the identification by patients reinforces the role they can play in identifying and reporting these risks.

Women's safety alerts in maternity care: is speaking up enough?

“…In recent years it has been argued that patients in acute and general healthcare settings have the potential to act as safety buffers by voicing concerns and pre-empting failures in care 10 32 33. Our analysis shows that women using maternity services also demonstrate this ability.…”

Patient Reporting of Safety experiences in Organisational Care Transfers (PRoSOCT): a feasibility study of a patient reporting tool as a proactive approach to identifying latent conditions within healthcare systems

“…As identified earlier, there is an increasing emphasis on the need for patients to be involved in their own safety,13 14 37 highlighted by the recent events and subsequent enquiries at Mid-Staffordshire NHS Foundation Trust 16 17. This need can be addressed through patient reporting of safety concerns or incidents,30 so that organisations can learn from the patient perspective.…”

“…The questions asked in each stage of the care transfer are provided in table 1, and focus around six domains: communication , responsiveness , waiting times , falls , medication and hygiene . These domains are based on patient perceptions of safety 14. Patients or their carers are asked to report on three levels of safety: safe (green), neutral (yellow) and unsafe (red), and to leave any non-applicable sections blank.…”

Patient Involvement in Patient Safety: Current experiences, insights from the wider literature, promising opportunities?

“…For example, in a study of patients' definitions of safety and harm in transitions of care, older people reported feeling unsafe during their transfers of care if not clearly communicated with (Scott, Dawson, and Jones 2012). Alongside the more traditional risks to patient safety such as falls, medication concerns, and health care acquired infections, the authors of this study suggested that an excess of trust of a patient in the clinical professionals treating him could act as a 'latent condition' that actually reduces the patient's ability to be involved in his safety.…”

“…Alongside the more traditional risks to patient safety such as falls, medication concerns, and health care acquired infections, the authors of this study suggested that an excess of trust of a patient in the clinical professionals treating him could act as a 'latent condition' that actually reduces the patient's ability to be involved in his safety. Improved communication, to provide a more solid foundation for trust and challenge between patient and clinician and ensure responsiveness to the patient's individual needs, was thus proposed as an additional safety step (Scott, Dawson, and Jones 2012). Entwistle et al (2010), too, highlight the importance of the way in which safety concerns are received by professionals in shaping the extent to which patients feel comfortable about 'speaking up' about safety concerns and call for a dual strategy, which encourages both patients to speak up and staff to listen to them.…”