Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention

Abstract

BackgroundDespite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a patient–teacher medical error disclosure and prevention training model.MethodsWe developed an educational intervention bringing together interprofessional clinicians with P/F from hospital advisory councils to discuss error disclosure and prevention. Patient focus groups and orientation sessions informed curriculum and assessment design. A pre-post survey with qualitative and quantitative questions was used to assess P/F and clinician experiences and attitudes about collaborative safety education including participant hopes, fears, perceived value of learning experience and challenges. Responses to open-ended questions were coded according to principles of content analysis.ResultsP/F and clinicians hoped to learn about each other's perspectives, communication skills and patient empowerment strategies. Before the intervention, both groups worried about power dynamics dampening effective interaction. Clinicians worried that P/F would learn about their fallibility, while P/F were concerned about clinicians’ jargon and defensive posturing. Following workshops, clinicians valued patients’ direct feedback, communication strategies for error disclosure and a ‘real’ learning experience. P/F appreciated clinicians’ accountability, and insights into how medical errors affect clinicians. Half of participants found nothing challenging, the remainder clinicians cited emotions and enormity of ‘culture change’, while P/F commented on medical jargon and desire for more time. Patients and clinicians found the experience valuable. Recommendations about how to develop a patient–teacher programme in patient safety are provided.ConclusionsAn educational paradigm that includes patients as teachers and collaborative learners with clinicians in patient safety is feasible, valued by clinicians and P/F and promising for P/F-centred medical error disclosure and prevention training.

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

“…A variety of methods are now available internationally for capturing patients' experience of services, levels of satisfaction, and increasingly, their perspective on the clinical outcomes of treatment. Patients are also now routinely invited to present their experiences of healthcare to board-level executives and within education 3 6. Additionally, patients are increasingly finding their own outlets for providing feedback online via dedicated patient websites or social media 7 8.…”

“…Over the past decade, the healthcare landscape has evolved, with patients and families now firmly placed at the centre of care design and delivery in both policy, and increasingly practice. However, as highlighted in two papers2 3 published in this issue of BMJ Quality & Safety , there remain significant challenges in the meaningful integration of the patient perspective in improving the safety of care. Why does involving patients in safety improvement remain so hard?…”

<b>Segurança do paciente na formação dos profissionais de saúde/Safety in the training of health professionals<b>

“…[...] foi muito discutido em várias disciplinas, que envolver e ensinar o paciente, o familiar ou cuidador no tratamento é fundamental para o sucesso e a melhora do paciente nas atividades. (T2) Para que o cuidado centrado no paciente ocorra, é preciso que os profissionais desenvolvam empatia, compaixão e capacidade de responder às necessidades, valores e preferências expressas pelo paciente ou familiar, além da transparência na assistência (15) . Portanto, é indispensável discutir esses aspectos na formação dos profissionais de saúde, de modo que possam ser efetivamente refletidos na prática.…”

“…No complexo sistema de saúde, há inúmeras partes interagindo simultaneamente, o que dificulta prever o comportamento e resultado do sistema como um todo (4) . Essa complexidade está relacionada, entre outros aspectos, com a diversidade das fontes de informação e relação entre os profissionais de saúde, as equipes, o paciente, a tecnologia e a necessidade de atuação em diferentes ambientes (15) . Tivemos a parte burocrática e técnica do SUS, mas nunca discutimos sobre pensar no paciente que passará por todo esse trâmite, só percebemos que ele se perde e, às vezes, não retorna de maneira adequada.…”

Embracing error

“…To address these barriers, Langer et al. flipped traditional roles by engaging patients and families to co‐design and lead a new education programme: ‘Patient‐Teachers in Patient Safety’ . Clinicians from various backgrounds – including doctors, nurses, nurse managers and social workers – were invited to participate.…”