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

Exploring patient participation in reducing health-care-related safety risks
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they do not routinely engage patients in discussions and decision-making (see Chapter
2). Even tasks that seem rather straightforward at first glance, such as marking a surgical
site, appear to be difficult for some patients. It should be borne in mind, therefore, that
patients are at their most vulnerable and least assertive in the acute inpatient setting (see
Chapter 7). Very few studies to date have provided information on the profile of patients
who are willing to participate (Chapter 4).
Self-management
Patient safety in the inpatient setting is first and foremost the responsibility of
professionals, although examples describing how patients can be involved as coproducers
of safe care are given in this report. Patient involvement is crucial. Patients in
ambulatory care are expected to adhere to medication regimes and instructions about
self-care without the constant presence of a health care professional. They or their family
members must assume responsibility for their own “quality control” (see Chapter 7).
They need comprehensive information, backed by scientific knowledge, to assume that
role, because adherence to medication instructions among chronically ill patients (for
example) is related to health literacy. The patient survey described in Chapter 5 revealed
that 65% of patients surveyed took more than five medicines every day, but that only
39% knew the names and dosages of the medicines they took. Knowledge of medicines’
names and dosages appeared to decrease with the increasing number taken.
Although the relationship between self-management, adherence to medication
instructions and literacy is well known, it is difficult to develop tools to address the
associated problems. Recommendations on patients’ health education are presented in
several chapters (Box 8.4).
The most promising combination of approaches is probably to work not only on
improving patients’ health literacy, but also to address the “patient literacy” of health
care professionals. There is a need to improve health professionals’ communication and
listening skills. Patients can provide feedback on doctors’ communication skills (see
Chapter 7). It may be useful to monitor professionals’ efforts to empower patients and to
improve patients’ self-management skills through surveys such as the CAHPS Health
Literacy Item Set or the Patient Activation Measure. Studies involving the latter have
shown that chronically ill patients’ activation levels can be improved and that this leads
to better self-management (see Chapter 7).
Conclusion
Milestones – set by European legislation – recommend that Member States promote
and emphasize the role of patients to improve quality and safety of health care (3−5).
These are complemented by the dedicated World Health Assembly resolutions and
continuous work of the WHO Patient Safety Programme, particularly through its work
on “Patients for Patient Safety”, and supported by the new WHO European health
policy framework (6).
The studies presented in this report show that patient safety and patient involvement
need to be addressed at different levels and from different perspectives. However,
there is as yet limited evidence for the effectiveness of patient involvement in safety