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

Exploring patient participation in reducing health-care-related safety risks
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Health literacy is an important precondition for reading and understanding patient
information about risks and benefits of medical procedures, about the course of a certain
disease and symptoms to watch for, about side-effects of interventions or medication,
and about safety management in general. A recent United States study showed that
about 60% of medical inpatients have limited health literacy. Patients in the lowest
literacy group were significantly older, were less educated and had a lower income (88).
Although limited health literacy is problematic in an inpatient setting, it is even more
so in outpatient, chronic care. Patients are willing to participate in safety management
in an inpatient setting, but health care professionals are ultimately responsible for the
delivery of safe care. In ambulatory care, however, patients must adhere to medication
regimes and follow instructions about self-care without the constant presence of a health
care professional. Patients must assume responsibility for their own “quality control”, for
implementing medical instructions and for making health decisions (89).
Adherence to medication instructions among chronic patients is often as low as 50%
and is related to patient knowledge. It has been shown that consumer understanding
of prescription drug information and self-management skills are lower for people with
lower health literacy rates (87,90). The relationship between self-management, adherence
to medication instructions and literacy is well known, but it still seems to be difficult to
develop tools to address the problem (91). Wolf & Cooper Bailey suggest improving
provider–patient communication, improving the readability of health materials such as
information leaflets and putting in place sustainable processes to routinely identify and
track patients who may be struggling to properly comply with medical instructions (89).
Generally speaking, the crucial counterpart of the empowered patient is the “patientliterate”
health professional. It is necessary to improve the communication and listening
skills of health professionals. Patients can be involved in providing feedback on doctors’
communication skills (92). As a means of providing systematic feedback, the CAHPS
Consortium has developed a set of questions that measure patients’ perspectives on
how well health care professionals communicate health information (93). Examples of
questions from the CAHPS Health Literacy Item Set include: “In the last 12 months,
how often did this doctor use medical words you did not understand?”; and: “In the
last 12 months, how often did this doctor use pictures, drawings, or models to explain
things to you?” Questions such as these are useful for monitoring professionals’ efforts to
empower patients and improve their self-management skills.
Another measure to assess health literacy and self-management skills is the Patient
Activation Measure developed by Hibbard et al. (94–99). Studies of its use show that
chronic patients’ activation levels can be improved and that this leads to better selfmanagement.
Hibbard concludes that by encouraging small and realistic steps toward
improving health, it is possible to improve self-management (98).
Although the patient–professional relationship is crucial when it comes to enhancing patient
involvement, this also places demands on health care systems. The Patient Involvement
in Patient Safety Research Group states that it should be made easier for professionals to
enable patient involvement in safety by, for example, ensuring a reasonable workload. The