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

hampered by the written and spoken word … [A]ll reports indicate that health literacy is not
independent of social factors and that population groups generally considered to be at risk for
health issues (including the elderly, the poor, those without a high school degree, those who have
limited resources, those who live in less resourced areas, and those who are members of minority
populations) are also more likely to have limited health literacy proficiencies.
Health literacy requires an integrated approach that addresses not only individuals’ skills,
demands and assumptions, but also the social factors and contexts that shape skills and
abilities.
Patient participation in patient safety
Increasing interest in encouraging patients and family members to contribute to
ensuring their safety as they use health services has been accompanied by concerns
about the appropriateness of safety-oriented patient activation initiatives and the limited
circumstances in which they can be effective (39,40). Ideas about the relationship
between health care staff and patients, including issues of trust and the allocation of
responsibility, are emerging as particularly important for understanding the potentials
and pitfalls of this process.
Patients’ and family members’ capability to contribute to their safety is strongly shaped
by health care provision features, especially interpersonal relationships with staff.
Patients and families are often unable or unwilling to adopt recommended behaviours to
promote safety, such as monitoring their care and speaking up about concerns , because
they appear (to them) to be challenging to, rather than collaborating with, health care
staff. This problem arises particularly when staff behaviour indicates disinterestedness
towards or mistrust of those patients, and when staff do not routinely engage patients in
discussions and decision-making processes. Attempts to involve patients to ensure their
safety as they use health services might risk shifting responsibility inappropriately to
patients if the interventions used are insufficient in the circumstances to enable patients
to act confidently and achieve the intended effects. While most patients may need more
support than is currently given, this issue is particularly pertinent for people whose
personal and social circumstances generally limit their capability for autonomy (40).
There is no requirement for patients to participate in patient safety activities. Many
patients are not willing to be involved, and their reasons should be respected. It is
important to invite and encourage patients to participate (“power of invitation”), but not
to pressure them (see Chapter 7).
SDM
SDM is defined as patient involvement with providers in making health care decisions
informed by the best available evidence about treatment and illness management
options, potential benefits and harms, and that take patient preferences into account.
SDM is important because many clinical decisions involve value judgements. Health
care providers cannot automatically interpret what patients value. Clinical evidence
and the patient’s perspective can only be incorporated in decision-making through an
explicit interaction between the health professional and the patient in which all relevant
information is elicited and evaluated. In doing so, SDM recognizes the ethical value of
Patients’ rights and patient safety
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