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

ChApTER 1.
pATIENTS’ RIGhTS AND pATIENT
SAFETY: INTRODUCTION
Diana Delnoij, Valentina Hafner
Introduction
In the rhetoric of modern health care systems, the patient role has evolved from passive
recipient of medical care to active, empowered and informed coproducer of health.
This is reflected in the way health care professionals and patients measure quality
of care, placing values such as patient centredness alongside effectiveness and safety.
Contemporary definitions of quality of care incorporate these perspectives. The Institute
of Medicine (IOM), for example, defines quality of care as: “doing the right thing, at the
right time, in the right way, for the right person, and having the best possible results” (1).
Several concepts, including safety, effectiveness, patient orientation, timeliness, efficiency
and equity, are considered essential to quality.
The issue of safety in health care has received considerable attention over the last decade
or so, fuelled by the publication in 2000 of the IOM report To err is human – building
a safer health system (2). The IOM estimated that between 44 000 and 98 000 people
in the United States died each year through medical errors and recommended that a
comprehensive approach be adopted to redesigning the health care system at all levels
to make it safer. Similar work has been carried out in several countries since the report’s
publication and national and international authorities have initiated patient safety
programmes.
This renewed emphasis places safety high on the health care agenda. Indeed, provision
of safe care has been a requirement for doctors since the early days of medicine.
Physicians in antiquity pledged to keep the sick from harm and “injustice” through
the Hippocratic Oath (3). The reference to “injustice” implies that patients had certain
rights, but it took another 2000 years for physicians’ obligations in relation to patients’
rights to be reflected in charters and laws, with the recognition and codification of
patients’ rights arising from the patient emancipation movement of the 1960s. Longtin
et al. (4) distinguish between humanist considerations (articulating the right to selfdetermination)
and consumerism, and emphasizing customers’ right to demand quality
services.
Patients in Europe have rights that implicitly or explicitly regulate aspects of care such
as access to safe care, provision of information about the risks and benefits of treatment
to facilitate informed consent and the right to complain. Patients’ rights may reflect
structural aspects of care (such as availability and affordability), norms for the process
of health care delivery (including informed consent) and situations in which either the
process or outcome of care gives rise to complaints (5).
Patients’ rights and patient safety: introduction
1