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

care professionals’ and patients’ reports: both groups report different adverse events and,
consequently, patient reports can complement professionals’ reports (84).
Of course, patient surveys only provide the patients’ perspectives on safety. Many
aspects of safety management take place “behind the scenes”, out of sight of patients.
This is also true of some of the safety aspects that are currently covered in patient
experience questionnaires, such as items relating to hand washing by doctors and nurses.
Patients’ reports should therefore always be used in combination with other sources of
information in public reports on the safety of care provided in health care facilities.
Limits to patient participation
Although there seem to be possibilities for patients to be involved in safety
management, it is essential to also be aware of the limitations. Not everyone is capable
of being involved. Even tasks that seem rather straightforward at first glance, such as
marking a surgical site, can be difficult for many patients. It is not altogether clear why
and how such things are problematic. Watt (85) concludes that:
[F]ew of the interventions have been evaluated for effectiveness or acceptability, many appear
to be ‘knee jerk’ reactions to adverse events and their theoretical basis has not been established.
There appears to have been little consideration of the mechanism of effect and of what
conditions and circumstances are required for patients to adopt safety roles.
The findings described in this chapter show that compliance with the request to mark
a surgical site is lower if more time elapsed between enrolment and the surgery, in
older patients and in those who do not use English as their primary language (11). This
suggests that some patients forgot the instructions given to them and that others were
not able to comprehend them in the first place.
On a more general level, difficulty in achieving patient involvement in how their care is
being delivered arises from a variety of aspects:
» patients are at their most vulnerable and least assertive in the acute care setting;
» the attitudes and behaviours of individual health care professionals may pose difficulties;
» it is not often habitual to invite patients to be partners in their care; and
» fear for the real or imagined possibility of being labelled a “difficult” or “overanxious”
patient also comes into play.
The degree to which patients are confident and competent to participate in safety
management and in reporting on safety in patient experience questionnaires is
related, among other things, to (health) literacy. Health literacy is “the ability to read,
understand, and act upon health information” (86). Apfel et al. (87) state:
Health literacy skills include basic reading, writing, numeracy and the ability to communicate
and question. Health literacy also requires functional abilities to recognize risk, sort through
conflicting information, make health-related decisions, navigate often complex health systems
and ‘speak up’ for change when health system, community and governmental policies and
structures do not adequately serve needs.
Patients’ experiences and patient safety
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