Exploring patient participation in reducing health-care-related safety risks

Patient participation in elective surgery safety in Portugal
da Saúde (DGS) [Directorate General of Health] of the Ministry of Health advises
that, despite having no legal basis for the requirement, if the hospital or unit clinical
director requires the use of informed consent forms, the physician has a duty to fulfil
this formality (48). Written consent should be obtained in this case, not due to legal
obligation, but to hierarchical bureaucracy (41, 48). The DGS also states that physicians
in private practice must enforce laws that impose written consent (48).
Complaint and compensation
Patients’ right to complain about the way they are treated is provided in the Basic Law
on Health (Article XIV) (Table 6.1) (31). The penal code (43) also provides for the right
to complaint and compensation in Article 1.156 (on medicosurgical interventions and
treatment without consent), under which prosecution depends on the user’s complaint.
Aiming to improve patient-centred health care and enhance patient participation, the
DGS recently created the NHS users’ suggestions and complaints management system,
“Yes citizen”. This is a network system that involves all public health care institutions in
the NHS and collects, lists, analyses and processes all complaints in the “livro amarelo”
[“complaints book”] or through citizens’ offices. It is recognized by the Ministry of
Health as a good example of citizen-centred health policy and is available to all citizens
anywhere within the national territory (49). Regional disciplinary councils of the
Portuguese Medical Association are responsible for dealing with complaints submitted
through its patients’ office (50−52).
Patient engagement and safety
The Basic Law on Health states in Article V that patients are responsible for their
individual and community health and have a duty to promote and protect it (30,31).
Patients are expected to cooperate with HCWs, providing information regarding
their health situation (31). They also have the right to form entities to represent them,
to defend their rights and cooperate with the health system (Article XIV). The law
encourages citizens and communities to participate in defining and planning health
policies and in monitoring how health services function (Article II). As the Ministry
of Health consulting body, the National Health Council represents all stakeholders
involved in the working process of health care entities, including patients (Article VII)
(31,40).
The DGS publishes an NHS users’ guide annually (53). This document aims to keep
citizens informed about available health services, relevant regulations and their rights
and duties so that they can act as partners in efforts to improve health quality (53).
Aiming to ensure protection of health service users’ rights (particularly in relation to the
right to information and right to choose), the ERS introduced the Sistema Nacional
de Avaliação em Saúde (SINAS) [National System of Health Evaluation] in 2006. The
aim of the SINAS is to evaluate health care institutions according to ratings within
different parameters, such as clinical excellence (already implemented), patient safety,
infrastructure, and – in future – patient satisfaction and comfort (not yet implemented).
Seven clinical areas are currently being evaluated: orthopaedics, gynaecology, obstetrics,
paediatrics, stroke, heart attack and ambulatory surgery (39).
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