The Essentials of Patient Safety - Clinical Human Factors Group

The Essentials of Patient Safety
Patient involvement in patient safety
Patients and their families have a critical, privileged perspective on many aspects of
healthcare. The patient may not, of course, understand the technical and clinical issues
at stake, but they do observe and experience the kindnesses, the small humiliations,
the inconsistencies in care, the errors and sometimes the disasters. In the case of
people with chronic illnesses they become experts not only on their own disease but
on the frailties, limitations and unintentional cruelties of their healthcare system. The
trouble is when we are patients, while we have great insight into the frailties of the
healthcare system, we find it astonishingly difficult to make our voice heard,
particularly where errors and safety are concerned.
Even an experienced senior doctor can find it hard to make their voice heard
when dealing with hospital staff caring for themselves or their family. Don Berwick,
currently head of Medicare in the United States, has movingly described his
experiences of being with his wife Ann during her treatment for a serious autoimmune
condition (1). In his account Don stresses the good will, kindness, generosity and
commitment of the healthcare staff but, even after two decades of grappling with the
quality and safety of healthcare, he was appalled at the operation of the healthcare
systems.
Patients, whether they have a clinical background or not, can provide
important safety information. Saul Weingart and his colleagues at Dana Farber
Cancer Institute in Boston (2, 3) interviewed 229 patients in hospital, who were both
willing and able to participate, asking them three general questions:
Do you believe that there were any problems with your care during this
hospitalisation
Do you believe that you were hurt or stayed in the hospital longer than
necessary because of problems with your care
Do you believe that anyone made a mistake that affected your care during this
hospitalisation
From these simple five minute interviews patients identified a host of process failures
such as problems with diagnosis, medication, procedures, clinical services (such as
radiology, phlebotomy and laboratory) and service quality. In a second study the
team found that patients reported many serious untoward events that were not found
in the medical record; however record review also revealed incidents and adverse
events that were not reported in patient interviews. Both record review and patient
reports are necessary to obtain a reasonably complete picture of the harm from
healthcare.
Patients are usually thought of as the passive victims of errors and safety failures, but
there is considerable scope for them to play an active part in ensuring their care is
effective, appropriate and safe. Instead of treating patients as passive recipients of
medical care, it is much more appropriate to view them as partners or co-producers
with an active role (4). The degree to which patients can be involved will vary
considerably depending on the nature and complexity of the treatment and the degree
of technical knowledge required to understand the treatment process. Most
importantly it will depend on the extent to which each person feels willing and able to
37