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

Exploring patient participation in reducing health-care-related safety risks
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ChApTER 7.
pATIENTS’ EXpERIENCES AND
pATIENT SAFETY
Diana Delnoij
Introduction
Patients’ health care experiences are being measured in several European countries as
part of national programmes of performance measurement and public disclosure of
performance indicators. These programmes often exist alongside national patient safety
programmes, but with little or no interaction. They are commonly run by different
agencies or different departments within one agency supported by different research
groups, and the link between patient experiences and patient safety is not always well
established, even within health care facilities.
There is nevertheless growing interest in the role patient participation can play in
enhancing patient safety and in the use of patient experience questionnaires as a tool
to monitor (factors that contribute to) safety risks. Rathert et al. argue that perceptual
measures of patient safety and quality can help to identify areas in which there are
higher risks of preventable adverse events (1), not only because patients interpret
lapses in service quality (such as delays in care, lack of coordination or poor hygiene) as
risks to their safety (2), but also because patients may be more perceptive about safety
problems than they have been given credit for. Taylor et al. (3), for example, showed
that poor coordination of care, poor interpersonal skills and unprofessional behaviour
were associated with the occurrence of adverse events, “close calls” or low-risk errors.
The authors provide two possible explanations for this finding. One is that patients’
experience of harm may increase their vigilance and critical assessment of service quality.
The other is that general attributes of the organization, such as the quality of interprofessional
and patient–clinician communication, may lead to service quality problems
as well as adverse events and errors (3).
The initiative “Patients for Patient Safety” was established as one of the action areas of
the WHO World Alliance for Patient Safety (Box 7.1). It aims to involve all actors,
including patients and families, in reform initiatives and safety improvements (4). It
is argued that patients ought to be seen as partners alongside health care providers in
efforts to improve patient safety and that self-reporting of adverse events provides useful
information for safety management (5). Patients themselves may be hesitant to assume a
leading role in ensuring safety, however: research indicates that patients – at least in the
acute care setting (that is, hospital) – believe they should be able to trust that they will
receive safe care delivered by competent HCWs (6).
Content of this chapter
This chapter explores patients’ various roles in safety management, as described in
Chapter 1. These roles include: