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

of a small-scale patient survey addressing understanding of written and oral
information on blood transfusion and patients’ recommendations with regard to
their involvement in the transfusion process.
» Chapter 5 described medication safety in Polish primary care. The study included
a review of legal documents and legal acts, and a survey of doctors’ and patients’
knowledge of medication safety. An overview of data from the RCMADR in
Kraków was also presented.
» In Chapter 6, Portuguese legislation and ethical codes relevant to elective surgery
safety were described. Portuguese data on surgical safety were also reviewed.
» Chapter 7 addressed three questions.
1. What are patients’ attitudes towards their involvement in patient safety?
2. What are the effects of involving patients in safety management?
3. What are the experiences of patients with respect to the occurrence of adverse
events, feeling safe and being actively involved in safety management?
The questions were answered through a study of the literature and a review of
patient experience questionnaires and related survey data.
In this final chapter, general conclusions are drawn and recommendations formulated,
addressing macro, meso and micro levels of health care. The conclusions and
recommendations are based on the evidence presented in the previous chapters.
Macro level
Many countries in the WHO European Region have adopted laws and regulations in
which patients’ rights are described. In Chapter 2, Legemaate refers to a recent overview
of national patients’ rights legislation in Europe by Nys & Goffin (1). The authors
conclude that the way in which patients’ rights are defined and implemented is largely
determined by national law and differs widely from country to country. In addition to
general legislation on patients’ rights, Legemaate describes specific legislation regarding
patient safety that has been implemented in, for example, Denmark and the United
States. The legislation of these two countries focuses on reporting adverse events and
regulating reporter protection.
No matter how important the definition of patients’ rights, Legemaate cautions readers as
to the limits of the law (2). Legal interventions are useful in increasing awareness, but the
law does not always reflect daily practice, as has been demonstrated in several chapters
of this report (see Box 8.1 for a summary). Legemaate argues that daily practices often
develop rather independently from the intentions of legislators and courts and are subject
to social, cultural, political, financial and practical processes. These processes influence the
effectiveness of legal interventions to improve the patient’s position. Legemaate therefore
stresses the importance of implementation. This is not the same as more regulation and
(further) juridification. 37 An example of juridification is the obligation in French law to
provide written information, when in fact patients seem to prefer oral information (see
Chapter 4). The right to information, according to Legemaate, forms the core of the
individual patient’s legal position: “Other rights lose their meaning or become ineffective
in the absence of adequate information” (see Chapter 2). Information is the key to patient
37 Referred to here as a process of increasing legal intervention.
Conclusions and recommendations
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