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

pREFACE
At the start of the 21 st century, the Institute of Medicine
report Crossing the quality chasm portrayed health care
systems as being motivated by payers and providers.
The lack of focus on the patient was considered
unacceptable and a call was made for greater patientcentred
care and engagement.
We must accept that the roles of health care provider and patient have evolved over
the last few years. Whereas the traditional model of care adopted a more paternalistic
approach on the part of the health care professional, the role of the patient has changed
to a more active one. Indeed, doctors today are continually greeted with patients who
have downloaded Internet-based information or consulted so-called experts via email
or social media on their health. Engaging patients intelligently in managing their
conditions has been shown to improve clinical outcomes. Indeed, the health care
systems of the future will be partnered with patients as coproducers of health, with
each party actively involved in charting the patient journey towards achieving a healthy
state. Moreover, as medicine continues to evolve, a greater repertoire of treatments and
technologies will be offered for complex conditions and providing patients with tools to
help in shared decision-making will be crucial to good outcomes. This key publication
by WHO provides the reader with a global view on different approaches that have been
taken to make patients equal partners in their health care decisions; the efforts range
across different specialties, such as primary care and surgery.
In some countries, such as the United Kingdom, patient engagement is enshrined in the
professional standards for health care professionals. Other countries have experimented
with patient charters and bills of rights. Eventually, patient feedback could form part
of a revalidation process for professionals. Indeed, these patients’ rights and health care
standards have been assessed in different settings throughout the report.
The principles of patient engagement have been less commonly addressed in patient
safety than in (say) fields such as chronic disease management. It is surprising, however,
to find many good examples in this document; the report serves as an excellent synthesis
of studies of patient engagement in the reduction of health care risks, as well as an
authoritative analysis of the concepts and debates that lie behind action programmes.
Despite these positive steps in Europe, greater efforts need to be made in creating
a culture that allows for coproduction of health care outcomes by the health care
professional and the patient. Educating both these parties on the merits of this approach
is crucial to the delivery of safer, optimal care.
It is interesting to reflect that President John F. Kennedy in 1962 set out the rights of
consumers generally. He identified four – the right to be informed, the right to be heard,
the right to choose, and the right to safety – a vision that applies well to the subject of
this report.
Sir Liam Donaldson
WHO Patient Safety Envoy
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