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

is provided through interaction of a patient with health care professionals and patient
self-management.
Patient–professional interaction
There is information asymmetry between health care professionals and patients:
consequently, the professional acts as the patient’s agent. This implies that the professional
is responsible for the patient’s safety, but also allows room for patient involvement. In
theory, patients can also stake a claim in terms of responsibility for their safety, but selfconfidence
and knowledge are required to question professional authority. The Bulgarian
study presented in Chapter 3, for example, shows that most respondents believed that
asking HCWs to wash their hands would prevent HAIs, but more than half stated
they would not feel comfortable asking their nurses or physicians to clean their hands.
Questioning authority is more difficult with doctors than nurses (see Chapter 7). It may
even seem easier to switch to another care provider when disagreement or dissatisfaction
arise or, if that is not an option, to simply not follow the doctor’s orders: this is referred
to as “nonadherence” or “noncompliance” and is a highly undesirable outcome of patient–
professional interaction. Health care professionals should therefore at least stimulate patient
involvement from the medical point of view, if not from an emancipator perspective.
There is evidence that patients with myocardial infarction who receive patient-centred
care have higher rates of survival after 12 months (see Chapter 7). It is not altogether
clear what the causal mechanism behind this is, but avoiding noncompliance may have
something to do with it.
Involving patients in decisions about their care and treatment is often referred to
as SDM (see Chapter 2). SDM is defined as the involvement of patients with their
providers in making health care decisions that are informed by the best available
evidence about treatment and illness management options and potential benefits and
harms, and which consider patient preferences. This is a necessary precondition to
guaranteeing informed consent. To provide consent, a patient needs clear and adequate
information that focuses on the nature of the condition, the (possible) effects and sideeffects
of proposed treatment, possible alternatives and the likely implications of not
treating. Legemaate argues in Chapter 2 that the importance of the right to information
goes beyond legitimizing consent; it may also strengthen the relationship between the
patient and the health professional and thereby stimulate patient compliance.
So, patient involvement is essential for many reasons. The question, however, is: do
patients want to be involved? The findings from the literature reviewed in Chapter 7
suggest that on a general level, patients and the public support an active role for patients
in error prevention. That said, patients are more likely to support traditional actions, such
as ensuring information transmission from patient to provider, rather than actions that
require them to challenge medical authority. Patients expect competent care and many
patients view their role as passive: they do not see patient safety as their responsibility.
In practice, many patients have difficulties in assuming an assertive and active position.
Patients are often unable or unwilling to speak up, particularly when HCWs behave in
ways that indicate they are disinterested in, or distrustful of, their patients, and when
Conclusions and recommendations
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