How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory

Abstract

BackgroundEfforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives.MethodsA qualitative semi-structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo-writing using the clustering technique were used to develop a model of how patients conceptualise patient safety.ResultsWhile some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them ‘feel safe’. Patients’ feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care.ConclusionsOur findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice.

Patient and family engagement interventions for hospitalized patient safety: A scoping review

“…To promote PFE in patient safety, it is important to first understand the patient's unique preferences and care needs (Sahlström et al., 2019). Because some evidence suggests that patients hold perspectives on patient safety distinct from those of HCPs and that patients' sense of safety is formed through a series of care experiences (Barrow et al., 2022). Patient advocate, a novel stakeholder for patients, can also provide assistance to patients in many aspects of health care, making it slightly less complicated (Cho et al., 2022; Lara & Salberg, 2009).…”

Reconceptualizing Patient Safety Beyond Harm

“…partners are rich sources to guide learning and improvements in care and workflow processes [1][2][3][4][5][6][7][8] by increasing awareness of potential safety risks and reducing adverse events. 1,5,[8][9][10] Patients and care partners offer unique perspectives to safety as they often identify types of safety risks, events, and outcomes that differ from those identified by health care professionals.…”

“…[11][12][13][14] Despite efforts, leveraging and learning from patients' and care partners' safety perspectives and experiences remain underutilized 1 for many reasons, including a failure to value and pay attention to their insights. This contributes to perpetuating a narrow understanding of safety, which is defined solely as the absence of harm, 4,5,15 thereby limiting safety conversations and improvements to care. Therefore, the purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety.…”

Emotional safetyispatient safety

“…3 In this issue, Archer et al contribute to this body of work. 4 The authors explored patients' conceptualisation of safety across three UK teaching hospital inpatient specialty wards in a qualitative interview study with a purposive sample of 24 English-speaking patients, 8 each from gerontology (medicine for the elderly), elective surgery and maternity (postnatal) wards. The authors found that patients in their study conceptualise safety as 'feeling safe' rather than 'being safe', and present a model of actions (performed, received, shared and observed) at the levels of self (patient), staff, family and friends, and the organisation that contribute to patients' 'feeling safe'.…”

“…A growing body of research on patients’ and families’ understanding and conceptualisation of patient safety1 2 begs the question of how and why we, in healthcare and the field of patient safety and quality, conceptualise patient safety as a domain separate from patient-centredness and patient experience 3. In this issue, Archer et al contribute to this body of work 4. The authors explored patients’ conceptualisation of safety across three UK teaching hospital inpatient specialty wards in a qualitative interview study with a purposive sample of 24 English-speaking patients, 8 each from gerontology (medicine for the elderly), elective surgery and maternity (postnatal) wards.…”