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

Exploring patient participation in reducing health-care-related safety risks
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In the ambulatory care setting, where HCWs are not present on a 24-hour basis, selfmanagement
is much more important, particularly for chronically ill patients and for
those with comorbidities. Chronically ill patients often welcome opportunities to be
more actively involved in care and also, therefore, in patient safety. They have become
experts in dealing with their own disease(s), therapies and medications and know how to
navigate the health system and deal with a variety of health professionals.
For chronic patients in an outpatient setting, safety issues often revolve around
medication safety. Patient involvement in medication safety has been studied by Hall et
al. (8). As was noted above, they concluded that the methodological quality of most of
the studies in this field was poor, making it difficult to draw conclusions about the safety
benefits of interventions. More research is needed in this area on, for instance, medication
safety as a joint responsibility of patients and pharmacists (76–79).
Effects of patient involvement
Various innovative interventions have been studied with respect to patient involvement
in the safety of hospital care. Interestingly, in one of the experiments concerning hand
washing, it turned out that the increase in soap usage by staff had already occurred in the
pre-programme period. Staff had anticipated the need to increase hand washing before
patients were encouraged to ask about hand hygiene. This shows that many improvements
are not discrete, single “before–after” changes, but instead follow an evolutionary path in
which the context of implementation is important (80,81). It also shows that the threat of
embarrassment which follows disclosure of unsafe behaviour is apparently a positive incentive
to improve hand hygiene. This resembles a phenomenon that has also been demonstrated for
public reporting of performance data. Public disclosure of substandard performance triggers
professionals and managers to improve the quality of care (62). This is related to the fact that
safety performance is an important attribute that determines patients’ choice of a hospital for
elective procedures, such as cataract surgery or hip or knee replacement (82).
A potential role for patients in safety management therefore lies in asking them to report
the occurrence of adverse event and to measure their experiences of safety management.
Patient experience surveys
The review of patient experience questionnaires showed that, despite the emphasis that has
been placed on safety after the IOM publication To err is human – building a safer health
system in 2000 (83), the CAHPS questionnaires contain only a few items related to patient
safety. Results of surveys in which these items have been used are scarcely available in the
public domain. Safety issues are nevertheless included in Commonwealth Fund surveys
conducted not only among the United States population, but also in samples of chronically
ill individuals in eight industrialized countries. A European survey in the Eurobarometer
series showed that on average, 26% of respondents stated that they or a member of their
family had experienced an adverse event while receiving health care (12).
Surveys conducted by the CQC and those of the CQI show that surveys provide a
useful tool in measuring patients’ experiences of various aspects of health care safety. This
is promising, as adverse events are generally underreported in complaints, claims and
incidence reports. In addition, there is little overlap in adverse events covered by health