Surrogate decision makers’ perspectives on preventable breakdowns in care among critically ill patients: A qualitative study

Fisher, Kimberly A.; Ahmad, Sumera; Jackson, Melissa; Mazor, Kathleen M.

doi:10.1016/j.pec.2016.03.027

Cited by 18 publications

(43 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Importantly, research has identified that patients do not see risks in the same way as clinicians (Christiaans et al., ; Kaboli et al., ). Highlighting the significance of involving patients in defining harm, a study investigating harm from the perspective of patients and their surrogate decision‐makers revealed that patient definitions of avoidable harm differed from conventionally defined medical error (Fisher, Ahmad, Jackson, & Mazor, ). In this study, participants identified avoidable harms that were unlikely to be acknowledged, or be the main concern for nurses.…”

Section: A Critical Lens On the Concept Of Unavoidable Harmmentioning

confidence: 99%

Technical rationality and the decentring of patients and care delivery: A critique of ‘unavoidable’ in the context of patient harm

Hutchinson

Jackson²,

Wilson

2017

Nursing Inquiry

View full text Add to dashboard Cite

In recent decades, debate on the quality and safety of healthcare has been dominated by a measure and manage administrative rationality. More recently, this rationality has been overlaid by ideas from human factors, ergonomics and systems engineering. Little critical attention has been given in the nursing literature to how risk of harm is understood and actioned, or how patients can be subjectified and marginalised through these discourses. The problem of assuring safety for particular patient groups, and the dominance of technical forms of rationality, has seen the word 'unavoidable' used in connection with intractable forms of patient harm. Employing pressure injury policy as an exemplar, and critically reviewing notions of risk and unavoidable harm, we problematise the concept of unavoidable patient harm, highlighting how this dominant safety rationality risks perverse and taken-for-granted assumptions about patients, care processes and the nature of risk and harm. In this orthodoxy, those who specify or measure risk are positioned as having more insight into the nature of risk, compared to those who simply experience risk. Driven almost exclusively as a technical and administrative pursuit, the patient safety agenda risks decentring the focus from patients and patient care.

show abstract

Section: A Critical Lens On the Concept Of Unavoidable Harmmentioning

confidence: 99%

Technical rationality and the decentring of patients and care delivery: A critique of ‘unavoidable’ in the context of patient harm

Hutchinson

Jackson²,

Wilson

2017

Nursing Inquiry

View full text Add to dashboard Cite

show abstract

“…As the ‘closest observers of care’, patients and family members have unique insights into how care is delivered 1. A growing body of research documents that when asked about their care experiences, patients and family members identify a variety of problematic events 2–10. Breakdowns in care, which we consider to be anything that has gone wrong in care from the perspective of the patient, encompass medical errors and adverse events identified by the patient, as well as other events—such as communication problems—that would not typically be classified as a medical error.…”

Section: Introductionmentioning

confidence: 99%

“…Breakdowns in care, which we consider to be anything that has gone wrong in care from the perspective of the patient, encompass medical errors and adverse events identified by the patient, as well as other events—such as communication problems—that would not typically be classified as a medical error. Breakdowns in care are distressingly common, with as many as 40% of hospitalised patients perceiving a breakdown in their care 2 3. Examples of patient-perceived care breakdowns include delayed diagnosis, inadequate information exchange, rude or dismissive manner, medication errors and problems with procedures 2.…”

Section: Introductionmentioning

confidence: 99%

“…Examples of patient-perceived care breakdowns include delayed diagnosis, inadequate information exchange, rude or dismissive manner, medication errors and problems with procedures 2. Almost all patient-perceived breakdowns cause emotional distress to patients and family members, and many result in loss of trust, avoidance of medical care and life disruption 2 3 9…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Communicating with patients about breakdowns in care: a national randomised vignette-based survey

et al. 2019

View full text Add to dashboard Cite

BackgroundMany patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed.ObjectiveTo identify factors which influence speaking up, and to examine the impact of apology when problems occur.DesignRandomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied.SettingNational online survey.Participants1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate.Main outcomes and measuresAffective responses to care breakdowns, intent to speak up, willingness to recommend the hospital.ResultsTwice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not ‘definitely’ speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer’s role influenced speaking up for two of the three breakdowns (rudeness and slow response).ConclusionsAsking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients’ willingness to recommend the hospital.

show abstract

“…1,10,11 Limited data collected using an open-ended approach suggest patient-perceived breakdowns in care may be very common. 2,12,13 However, the impact of such breakdowns on patients has not been well characterized.…”

mentioning

confidence: 99%

We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care

Fisher

Smith

Gallagher

et al. 2017

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

Surrogate decision makers’ perspectives on preventable breakdowns in care among critically ill patients: A qualitative study

Cited by 18 publications

References 38 publications

Technical rationality and the decentring of patients and care delivery: A critique of ‘unavoidable’ in the context of patient harm

Technical rationality and the decentring of patients and care delivery: A critique of ‘unavoidable’ in the context of patient harm

Communicating with patients about breakdowns in care: a national randomised vignette-based survey

We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care

Contact Info

Product

Resources

About