Finding the patient in patient safety

Abstract

In the last decade, the field of patient safety has grappled with the complexity of health-care systems by attending to the activity of frontline clinicians. This article extends the field by highlighting the activity of patients and their carers in determining the safety of these systems. We draw on data from three studies exploring patients' accounts of their health-care experiences in Australia and internationally, to show how patients and carers are currently contributing to the safety of their own care. Furthermore, we emphasise the importance of patient-clinician collaboration in ensuring the success of these activities. We argue that it is no longer sufficient to discuss if patients should be involved with ensuring their own safety. Given that patients are already involved, we propose a new conceptualisation of safety and systems that acknowledges their involvement and supports patient-provider collaboration to achieve safer care.

Elective surgical patients' narratives of hospitalization: The co-construction of safety

“…Approaches to improving safety, which focus on implementing incident reporting systems, checklists and protocols, fail to address the patients' part in the negotiated process of healthcare and the importance of clinicians' benevolence in maintaining trust within the social-cultural context in which care takes place. Our results add further evidence to calls for the development of healthcare specific, rather than industry derived, approaches to inform and improve patient safety which embrace the patients' involvement in the negotiated process of healthcare (Hor, Godbold & Iedema, 2013;). …”

“…Although many patients may be willing and able to monitor and protect their safety, success of their efforts is crucially dependent on clinicians' willingness to listen and act on the patients' concerns (Hor et al, 2013). Waring (2009) demonstrates how the construction of safety and harm in healthcare is contested terrain where, by intersubjective processes, knowledge is constructed and re-constructed to serve the interests of the various managerial and clinical stakeholders.…”

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

“…In general, though, the published evidence focuses on attitudes and expectations rather than on the opportunities for patient involvement in patient safety and the results of these. Some articles directly explore patient experiences of safety concerns Entwistle et al 2010), and a few consider their views on educational materials designed to involve them in safety issues (Schwappach and Wernli 2010;Rance et al 2013;Rainey et al Forthcoming;Pinto et al 2013;Hor et al 2013). In addition, a few studies use surveys and questionnaires to ascertain patients' willingness to be involved in direct challenge to professional practice, on issues such as hand hygiene, or their willingness to report adverse drug events (Pittet et al 2011), and one article discusses the use of patient feedback in real time (Hibbard et al 2005).…”

“…Vincent and Coulter (2002) have suggested that patients should be regarded as partners or co-producers in their care and argue that, without patient involvement, the patient safety movement is incomplete. Similarly, Hor et al (2013) have criticized the traditional model of patients as unreliable witnesses and the conceptualization of patient safety as something that resides in a set of actions external to the patient. Rather, they argue that safety is co-accomplished on an ongoing basis; patients are already taking responsibility for their care through their negotiations with clinicians.…”

“…The in-depth personal knowledge, self-motivation, and presence of the patient throughout the course of her treatment are all potential resources for improving safety of care, but they should not give rise to an obligation on the patient to maintain constant vigilance for safety issues -and less still something that transfers responsibility away from staff, divesting them of their professional responsibility. Rather, Vincent and Coulter's (2002) and Hor et al's (2013) acknowledgement that accomplishing care is a collaborative endeavour between patient and professional offers some promise in terms of conceptualizing how patients might be enfranchised in relation to patient safety, without shifting responsibility and undermining the therapeutic relationship. However, as we see below, exactly how this might be accomplished in practice, and how far it is possible for patients with differing levels of capacity and in positions that are often characterized by vulnerability and disempowerment, is not straightforward.…”