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

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Exploring patient participation in reducing health-care-related safety risks 130 Fig . 7 .3 . Inpatient experiences in NHS hospitals, 2010 Were you told about any warning signs you should watch for after you went home? Were you told about medication side-effects to watch for when you went home? Were you given any information about what you should or should not do after leaving hospital? Were you told how you could expect to feel after you had the operation or procedure? Did nurses wash or clean their hands between touching patients? Did doctors wash or clean their hands between touching patients? Did you have confidence in the nurses treating you? Did you have confidence in the doctors treating you? % 0 20 40 60 80 100 Source: Department of Health (75). Always/Yes Sometimes/To some extent did not happen (as far as they knew). For nurses, the percentages were 79% (“always”) and 4% (“never”). No Feeling safe Seventeen per cent said they “sometimes” and 3% “never” had confidence and trust in the doctors treating them. For nurses, the percentages were 22% and 3% respectively. Ten per cent felt that there were “rarely or never” enough nurses to care for them during their hospital stay (Fig. 7.3). Being actively involved Eighty-eight per cent of respondents were not asked to give their views on the quality of their care while in hospital and 58% did not see posters while in hospital explaining how to complain about care they received. Eurobarometer: patient safety and quality of health care The European Commission has been monitoring the evolution of public opinion in EU Member States since 1973. Public opinion is monitored through the “Eurobarometer”, which consists of standard and special surveys. Special surveys take place for in-depth studies and are integrated in the standard Eurobarometer polling waves. A special Eurobarometer survey was carried out in 27 EU Member States in September and October 2009. The survey focused on Europeans’ perceptions of patient safety, their attitudes toward the quality of health care in their country and their actual experiences regarding adverse events. This special Eurobarometer was part of wave 72.2 of the Eurobarometer surveys (12) covering the population of the respective Member States. Residents aged 15 years and over were sampled via a multistage random design, with a
probability proportional to population size and density. The respondents represented the whole territory of the countries surveyed, according to the distribution of the resident population. Interviews were conducted face to face in people’s homes and in their national language. A total of 26 663 interviews were completed (12). The findings in relation to actual experiences of Europeans are described in this section. Adverse events Twenty-six per cent of respondents said that they or a member of their family had experienced an adverse event when receiving health care. Percentages were highest in Sweden (49%), Denmark (43%), Latvia (43%) and the Netherlands (42%) and lowest in Austria (12%), Portugal (13%), Italy (15%) and Bulgaria (15%). More adverse events were reported by respondents who were aged between 40 and 54 years and were educated to a higher level, who worked as managers (compared to other occupational groups) and who frequently had problems paying their bills. Patients’ attitudes, involvement and experiences There is increased interest in the role of the patient in safety management. Three questions have been addressed in this chapter. 1. What are patients’ attitudes towards their involvement in patient safety? 2. What are the actual effects of involving patients in safety management? 3. What are the experiences of patients with respect to: • the occurrence of adverse events; • safety management in health care facilities; and • being actively involved in safety management and feeling safe? Attitudes Patients seem to be rather conservative in defining their role. “The patient role is to follow instructions” and “patients should expect competent care” are the two most frequently mentioned comments in the qualitative study by Rathert et al. (1), although it should be noted that this study was carried out among patients who had been in hospital. The potential role of patients in an acute care setting such as a hospital should not be overestimated. Many are not capable of active involvement, not even when they are explicitly invited to be involved in, for instance, marking a surgical site or questioning staff about hand washing. The studies described in this chapter show that it is possible to stimulate a certain group of patients to ask about hand washing or mark a surgical site, but confronting medical professionals and questioning medical authority is something that many patients find difficult. In the experiments that have been described in the relevant literature, about 91% of patients asked a nurse about hand washing, but only 33% “dared” to ask a doctor. Netherlands patients, among whom roughly one third stated that their doctor was never/sometimes willing to talk about things that had gone wrong, also reported such responses. It should be borne in mind that people are at their most vulnerable in a hospital setting and it is questionable whether they should be encumbered with the additional burden of being responsible for ensuring their own safety. Participation and involvement should not imply that professionals devolve responsibility for safety to patients. Patients’ experiences and patient safety 131
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Exploring patient participation in
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ABSTRACT Patients’ rights have be
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iv Patient information: the link be
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vi LIST OF TABLES, FIGURES AND BOXE
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ACKNOWLEDGEMENTS The editors would
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LIST OF ABBREVIATIONS ABHR alcohol-
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FOREWORD Health is a social value a
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ChApTER 1. pATIENTS’ RIGhTS AND p
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Box 1 .1 . contd Reporting and Lear
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The causal mechanisms through which
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» be involved in routine monitorin
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elationships within the complex env
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ChApTER 2. pATIENTS’ RIGhTS AND p
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CoE Recommendation 2006/7 of the Co
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The 2005 United States act on patie
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The right to participate in policy-
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The right to participate in quality
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» engaging with patient representa
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hampered by the written and spoken
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prevents misunderstandings and shap
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Health care providers should nevert
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Recommendation 7 - Encourage the av
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20. Constitution of the World Healt
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ChApTER 3. pATIENT pARTICIpATION IN
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awareness of the sociomedical burde
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Patient participation in hand hygie
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Blood transfusion safety in France:
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Box 4 .1 . Definitions of adverse e
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Fig . 4 .4 . Distribution of advers
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The heterogeneity of situations and
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Fig . 4 .12 . Patients’ response
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Patient safety, rights and medicati
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Page 97 and 98: Fig . 5 .3 . Frequency with which d
Page 107 and 108: ChApTER 6. pATIENT pARTICIpATION IN
Page 109 and 110: Patient participation in elective s
Page 111 and 112: e desirable to have a special statu
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Page 133 and 134: » being involved in monitoring and
Page 135 and 136: Other studies on patient attitudes
Page 137 and 138: Information about patients’ exper
Page 139 and 140: available evidence suggests that in
Page 141 and 142: Adverse events Respondents from the
Page 143: Feeling safe Five per cent of hospi
Page 147 and 148: care professionals’ and patients
Page 149 and 150: group recommends that patient invol
Page 151 and 152: 13. Hibbard JH et al. Can patients
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Page 155 and 156: 2009 (http://www.bradfordresearch.n
Page 157 and 158: of a small-scale patient survey add
Page 159 and 160: Box 8 .2 . Curricula and CME Chapte
Page 161 and 162: is provided through interaction of
Page 163 and 164: Box 8 .4 . Patient education Chapte
Page 165 and 166: ANNEX 1. QUOTATIONS FROM INTERNATIO
Page 167 and 168: (2) When designing adverse event re
Page 169 and 170: 17) If yes, do you think this was m
Page 171 and 172: Box A3 .1 . Reporting procedure Pat
Page 173 and 174: Box A3 .2 . contd Haemosiderosis Ha
Page 175 and 176: ANNEX 4. pATIENT QUESTIONNAIRE ABOU
Page 177 and 178: ANNEX 6. WhO pATIENT SAFETY pROGRAM
Page 179 and 180: especially those in intensive care.
Page 181 and 182: ANNEX 7. hANDOVER pROjECT Paul Bara
Page 183 and 184: (a) Provide new insight into the ro
Page 185 and 186: Johnson J, Barach P. Handovers of p
Page 187 and 188: Enhancing the patients’ role in p
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Exploring patient participation in reducing health-care-related safety risks

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