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

The right to participate in quality assurance schemes
Responsibility for delivering safe and good-quality health care has to be fulfilled in
the first instance by health care providers and cannot be transferred to the patient.
Fulfilling this responsibility implies that patient views and experiences are collected
in a systematic manner and that they are taken seriously. Article 3(c) of the European
Council recommendation on patient safety (7) stipulates that patients, relatives and
informal caregivers should be given opportunities to report their experiences. There are
many well-developed and well-researched ways to collect patients’ views and experiences
in health care settings, including interviewing patients, using methods such as the
Consumer Quality Index (CQI), analysing social media messages and enabling patients
to report incidents and adverse events. If it is a legal obligation to deliver patient-centred
health care that is adjusted to patients’ needs (as suggested above), it is also necessary
to develop a systematic way to collect and analyse the views and experiences of patients
and/or patient organizations.
The right to participate in quality assurance schemes has both an individual and
collective dimension. It aims to use patients’ views and experiences derived at individual
and group levels to improve safety and quality. At individual level, it is important to
prevent the transfer of inappropriate (legal or medical) responsibilities to the patient.
This right has to be distinguished from educating patients to improve their health
condition and/or to be aware of factors that may threaten the safety or effectiveness of
the health care they receive. These are very important issues, but tend to represent an
obligation or challenge for governments and health care providers rather than being
enforceable patients’ rights.
The right to complain
The legal position of patients in health care should be based on three elements:
1. substantive rights (including access to health care, informed consent and privacy);
2. procedural rights (right to complain and other mechanisms to enforce patients’
rights); and
3. adequate information about the existence and content of applicable substantive and
procedural rights.
The right to complain is of vital importance in this context, not only as a tool to
enforce compliance with existing rights, but also to create a forum in which rights and
entitlements that have not yet been set out in legislation or case law can be debated.
Seen from the perspective of the health care provider, complaints lodged by patients or
their family can be used as indicators to evaluate and – if necessary – improve the safety
and quality of care. Each complaint is free advice. It is inherent to the delivery of health
care, as to any service, that patients may be dissatisfied with services offered. Health
service providers have to respond to this in a constructive manner, avoiding defensive or
legalistic responses. For that reason, the CoE recommendation requires “the existence of
a fair and open complaints system” (8).
Patients’ rights to complain can be shaped and implemented in various ways, ranging
from the services of informal, easily accessible patient advocates or complaint officials
Patients’ rights and patient safety
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