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

Exploring patient participation in reducing health-care-related safety risks
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for 2009–2011 using a combination of the medical subject headings “participation,
patient” and “safety management”, and search limits “humans”, “abstract” and “English”.
This resulted in 32 references, including the two systematic reviews. The 32 references
have been screened on the basis of their abstract. This resulted in the identification of
three additional references in which empirical findings were presented (6,10,11).
Screening of patient experience surveys
The following patient experience questionnaires have been screened:
» Consumer Assessment of Healthcare Providers and Systems (CAHPS)
questionnaires used by the American Agency for Healthcare Research and Quality;
» questionnaires of the Commonwealth Fund;
» CQI questionnaires of the Dutch Centre for Consumer Experience in Health
Care; and
» questionnaires used by the Care Quality Commission (CQC) in United Kingdom
(England). 36
Findings of surveys in which these questionnaires have been used are presented.
Findings from a European Commission survey focusing on patient safety and quality of
health care (12) are also described.
Results of the literature review
Patient attitudes towards involvement in safety
Schwappach (9) reviewed 21 publications that investigated the participation of
individual patients in safety-related actions or prevention strategies. Of these, 13
assessed patients’ attitudes towards systematic engagement in safety. Schwappach
concludes that generally, patients and the public support an active role for patients in
error prevention, but that patients’ attitudes towards specific error-prevention strategies
vary. Patients are more likely to support traditional actions, such as ensuring information
transmission from patient to provider, rather than actions that require them to challenge
medical authority. For example, the majority of people in one of the studies reviewed
by Schwappach stated that they would be “likely” or “very likely” to find out about the
results of a test at the hospital in the event that they had not been informed, but were
“not likely” or “not at all likely” to ask HCWs whether they had washed their hands (13).
Patients are more willing to communicate with or complain about nurses than about
physicians (9) (see also the section below, “Patient participation in error prevention:
hand hygiene”) and tend to overestimate health care professionals’ capacity to address
and solve all issues that might arise. Schwappach refers to the study by Abbate et al. (14)
in which patients were asked whether they would stop providers who were not wearing
gloves. They were most willing to intervene if they had never been exposed to a provider
not wearing gloves: in other words, they thought they would intervene if they had not
yet experienced how difficult it can be in practice to confront a provider.
36 For practical reasons, the work has been be limited to questionnaires in English and in Dutch. The Norwegian Knowledge
Centre for Health Services runs a national programme to measure hospital patients’ experiences with patient safety. However,
these surveys and the reports are only available in Norwegian (Øvind Andresen Bjertnæs, Director of the Norwegian
Knowledge Centre for Health Services, personal communication, 2012).