Patient participation in patient safety still missing: Patient safety experts' views

Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study

BACKGROUND

Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.

METHODS

This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach.

RESULTS

Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: 'structure', 'culture', 'education', 'emotional', and 'physical and technology'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients.

CONCLUSIONS

Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, 'politics'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations' structure, culture and practices.

Problematic substance use among patients in a Swedish outpatient psychiatry setting: staff and manager perceptions of digital options for increased intervention access

BACKGROUND

Approximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study "digital interventions" comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting.

METHOD

The study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data.

RESULTS

Three themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients' technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future.

CONCLUSIONS

The study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.

Healthcare professionals' perception of knowledge and implementation of Patient Safety Incident reporting and learning guidelines in specialised care units, KwaZulu‑Natal

Background

Despite the implementation of intervention strategies, incidents in specialised care units remain high and are of serious concern, worldwide.

Objectives

To assess the healthcare professionals' perception of knowledge and implementation of patient safety incident (PSI) reporting and learning guidelines in specialised care units of three selected public hospitals in KwaZulu-Natal, South Africa.

Methods

The study used a descriptive, cross-sectional survey design. A purposive sample targeted 237 healthcare professionals. An online structured questionnaire collected the data. Descriptive and inferential statistics were used to analyse data.

Results

A total of 181 questionnaires were returned, yielding a response rate of 76%. Notably, 83% of respondents had high-perceived knowledge of the PSI reporting and learning guidelines, while 98% had low perceptions of their implementation. The current unit (p=0.002) and shift of the day (p=0.008) were factors associated with the perception of good knowledge of PSI reporting and learning guidelines, as indicated by a p-value ≤0.05. The respondents' age (p=0.05), current unit (p=0.015), and shift of the day (p=0.000) were significantly associated with the perception of poor implementation of the PSI reporting and learning guidelines.

Conclusion

The respondents demonstrated a good perception of knowledge of PSI reporting and learning guidelines; however, the perception of the implementation was poor. Therefore, a revised implementation strategy coupled with periodical in-service training for healthcare professionals is recommended, to foster and facilitate effective adherence to PSI reporting and learning guidelines.

Contributions of the study

This study highlights the healthcare professionals' perception of knowledge and implementation of the Patient Safety Incident reporting and learning guidelines in specialised care units in South Africa. The results identified weaknesses in the implementation of the guidelines; hence the necessity for the development of effective strategies to improve patient safety.

Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study

OBJECTIVES

This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS.

DESIGN

The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.

SETTING

EMS organisations from Finland's five healthcare districts.

PARTICIPANTS

EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.

RESULTS

Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'.

CONCLUSIONS

The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.

Patients' experience of patient safety information and participation in care during a hospital stay

AIM

Having a culture of safety is crucial when providing high-quality health care, yet preventable adverse events are common in the Swedish healthcare system, especially in the field of surgical care. Research shows that patient participation can improve patient safety. This study aimed to explore patients' experience of the safety leaflet, "Your safety in hospital," including participation in care and feelings of safe care.

DESIGN

This study uses a descriptive qualitative study design.

METHODS

Twenty patients from surgical wards received patient safety leaflets and participated in semi-structured interviews during their hospital stay. Data were analysed using qualitative content analysis.

RESULTS

Three categories emerged from the analysis: Positive and negative experiences of provided information, Experiences of participation in own care, and Feelings of being safe arising from a perception of good quality care. Most participants were satisfied with their participation in their care and felt safe during their hospital stay. Oral information about the safety leaflet from healthcare personnel was lacking.

ANÁLISE DO CONCEITO DE PACIENTE EXPERT SEGUNDO O MODELO DE WALKER E AVANT

RESUMO Objetivo: analisar o conceito de Paciente Expert no modelo de Walker e Avant. Método: análise teórica de conceito realizada em novembro de 2019 em bases de dados nacionais e internacionais com amostra final de 21 estudos, nos quais investigaram-se o país, ano de publicação, área da saúde, participantes, conceito, atributos, antecedentes e consequentes. Os dados quantitativos foram analisados de forma descritiva simples e os qualitativos organizados em figuras. Os conceitos identificados foram processados com apoio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: destacaram-se o Reino Unido (10, 47,6%); o ano de 2015 (04; 19,1%); a enfermagem como área de conhecimento mais evidenciada (05; 23,8%); e pacientes como participantes (18; 72,0%). A respeito dos elementos teóricos, a autogestão do cuidado (04;19,5%) foi o atributo que mais sobressaiu; evidenciaram-se, ainda, o aumento de pessoas com doenças crônicas (10;18,5%) como antecedente, a integração social/comunitária (14;24,5%) em meio aos consequentes, e os vocábulos patient expert, condition e health mediante o processamento dos conceitos apresentados pelos estudos incluídos na amostra final. Conclusão: a análise conceitual permitiu determinar a origem do conceito Paciente Expert, os diferentes campos de atuação desse sujeito, as habilidades desenvolvidas em prol do autocuidado e o seu real significado, o qual é definido como um indivíduo ativo no seu autocuidado com habilidades necessárias para gerenciar sua condição clínica e auxiliar outros em situação semelhante.

ANALYSIS OF THE EXPERT PATIENT CONCEPT ACCORDING TO WALKER AND AVANT'S MODEL

ABSTRACT Objective: to analyze the Expert Patient concept in Walker and Avant's model. Method: theoretical concept analysis conducted in November 2019 on national and international databases with a final sample of 21 studies, in which the following data were investigated: country, year of publication, area of knowledge, participants, concept, attributes, antecedents, and consequences. The quantitative data were analyzed in a simple descriptive way and the qualitative data were organized in figures. The concepts identified were processed with the aid of the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results: the United Kingdom (10; 47.6%) stood out, as well as the year 2015 (04; 19.1%), Nursing as the most evidenced area of knowledge (05; 23.8%), and patients as participants (18; 72.0%). With regard to the basic elements, care self-management (04;19.5%) was the most relevant attribute; in addition, the increase in the number of people with chronic diseases (10;18.5%) and social/community integration (14;24.5%) were evidenced as the most important antecedent and consequence, respectively. Additionally, the terms expert patient, condition and health stood out in the processing of the concepts presented in the studies included in the final sample. Conclusion: concept analysis allowed determining the origin of the Expert Patient concept, the different fields of action of this subject, the self-care skills developed and their actual meaning, which is defined as an individual actively engaged in self-care and with the required skills to manage their clinical condition and help others in a similar situation.

Nurses' view of implementation evidence-based fall prevention interventions: A qualitative study

AIM

The purpose of this descriptive qualitative study was to evaluate nurses' views of implementation evidence-based fall prevention interventions.

METHODS

The study was conducted with participation of nurses who worked in a training and research hospital after evidence-based fall prevention interventions had been implemented. Interviews were done with 17 nurses who participated in all training courses.

RESULTS

The evaluation of the interventions was examined, and three themes were extracted through analysis: 'effectiveness of training programme', 'barriers' and 'suggestions'.

CONCLUSION

Nurses emphasized that evidence-based fall prevention interventions are usable in hospital, but team collaboration and administrative support are required for better outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

The study result shows that fall prevention interventions should be introduced to all health care professionals, through the use of various training methods. Training should be given to patients and their caregivers, and barriers that nurses stated like understaffing, lack of materials and tools that ensure patient safety and internet (research/scientific information) access restriction should be reduced.

Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis

AIMS

To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety.

METHODS

We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results.

RESULTS

Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources.

CONCLUSION

Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.

Patient participation in care safety: Primary Health Care professionals' perception

OBJECTIVES

to analyze health professionals' perception about the meaning and practice of patient involvement in care safety in Primary Health Care.

METHODS

this is an exploratory, qualitative study, developed with 22 professionals in the Federal District, Brazil. A semi-structured interview was conducted between October and November/2018. Content analysis was carried out according to Bardin.

RESULTS

nurses, physicians, dentists, among others, participated. The following categories emerged: Meaning of patient involvement in care safety; Factors intervening in patient involvement in care safety; Strategies for patient involvement in care safety; Qualification for patient involvement in care safety.

FINAL CONSIDERATIONS

the meaning of patient involvement for care safety was associated with co-responsibility and patient-centered care. Professionals' practice revealed intervening factors and the use of involvement strategies. A gap was identified in training on patient involvement in care safety.

Broadening the concept of patient safety culture through value-based healthcare

Purpose

Decision-makers are looking for innovative approaches to improve patient experience and outcomes with the finite resources available in healthcare. The concept of value-based healthcare has been proposed as one such approach. Since unsafe care hinders patient experience and contributes to waste, the purpose of this paper is to investigate how the value-based approach can help broaden the existing concept of patient safety culture and thus, improve patient safety and healthcare value.

Design/methodology/approach

In the arguments, the authors use the triple value model which consists of personal, technical and allocative value. These three aspects together promote healthcare in which the experience of care is improved through the involvement of patients, while also considering the optimal utilisation and allocation of finite healthcare resources.

Findings

While the idea that patient involvement should be integrated into patient safety culture has already been suggested, there is a lack of emphasis that economic considerations can play an important role as well. Patient safety should be perceived as an investment, thus, relevant questions need to be addressed such as how much resources should be invested into patient safety, how the finite resources should be allocated to maximise health benefits at a population level and how resources should be utilised to get the best cost-benefit ratio.

Originality/value

Thus far, both the importance of patient safety culture and value-based healthcare have been advocated; this paper emphasizes the need to consider these two approaches together.

Identifying Factors Leading to Harm in English General Practices: A Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis

OBJECTIVE

The aim of the study was to identify the main factors leading to harm in primary care based on the experiences reported by patients.

METHODS

We conducted a mixed-methods, cross-sectional study in 45 primary care centers in England. A random sample of 6736 patients was invited to complete the Patient-Reported Experiences and Outcomes of Safety in Primary Care questionnaire. We fitted structural equation modeling on the quantitative data (n = 1244 respondents) to identify contributory factors and primary incidents leading to harm. We conducted content analyses of responses to seven open-ended questions (n = 386) to obtain deeper insight into patient perceptions of the causes of harm experienced. Results from quantitative and qualitative analyses were triangulated.

RESULTS

Patients reported harm related to physical health (13%), pain (11%), and mental health (19%) and harm that increased limitations in social activities (14%). Physical harm was associated with incidents affecting diagnosis (β = 0.43; delayed and wrong), and treatment (0.12; delayed, wrong treatment, or dose), which were in turn associated with incidents with patient-provider communication, coordination between providers, appointments, and laboratory tests. Pain was associated with laboratory tests (0.21; caused when collecting blood or tissue samples) and with problems booking an appointment when needed (0.13; delaying treatment for pain). Harm to mental health was associated with incidents related to the following: diagnosis (0.28), patient-provider communication (0.18), appointments (0.17), coordination between different providers (0.14), and laboratory tests (0.12). Harm increasing limitations in social activities was associated with incidents related to diagnosis (0.42) and diagnostic and monitoring procedures (0.20).

CONCLUSIONS

Our findings suggest the need for patient-centered strategies to reduce harm in primary care focusing on the improvement of the quality of diagnosis and patient-provider communication.

Patients' perceptions of safety in emergency medical services: an interview study

BACKGROUND

Research on patient safety in emergency medical services (EMS) has mainly focused on the organisation's and/or the EMS personnel's perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients' experiences of their sense of safety in EMS.

METHODS

A qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used.

RESULTS

Patients' experiences of EMS personnel's ability or inability to show or use their medical, technical and driving skills affected the patients' sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients' perceptions of safety in EMS were connected to their confidence in the EMS personnel.

CONCLUSIONS

Overall, patients felt safe during their EMS encounter, but the EMS personnel's professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients' perceptions of safety can be used in improving safety in EMS.

Patient experience in co-production of care: perceptions about patient safety protocols

Objective:

to analyze the experience of the patient during hospitalization, focusing on the co-production of care related to patient safety protocols.

Method:

qualitative study, whose data were collected through the triangulation of multiple sources: document analysis, observation of 10 professionals in the provision of care and 24 interviews with patient-families from 12 clinical and surgical inpatient units of a hospital. Thematic analysis was carried out, based on the concept of co-production.

Results:

safety protocols according to the experience of the patient portrayed the role of patient-families as co-producers of safe care. It was found an alignment between perceptions of the patients, institutional definitions and basic national and international patient safety protocols. However, these protocols are not always followed by professionals.

Conclusion:

co-production was perceived in the protocols for safe surgery and prevention of injuries resulting from falls. In patient identification, hand hygiene and medication process, it was found that co-production depends on the proactive behavior of patient-families, as it is not encouraged by professionals. The research contributes with subsidies to leverage the participation of the patient as an agent of their safety, highlighting the co-production of health care as a valuable resource for advancing patient safety.

Symptoms patients receiving manual therapy experienced and perceived as adverse: a secondary analysis of a survey of patients' perceptions of what constitutes an adverse response

Background: Previous qualitative studies demonstrated that the process by which patients determined whether a response to manual therapy is adverse is very complex. However, it remains unknown which responses to manual therapy patients perceived as adverse. Objective: To describe symptoms patients experienced and perceived as adverse following manual therapy and to explore predictors of adverse responses (AR) for the body region with the greatest number of AR. We hypothesized that patients receiving manual therapy for neck conditions would present with more symptoms perceived as AR. Methods: This was a secondary analysis of a previous cross-sectional survey of 324 patients receiving manual therapy from Canadian physiotherapists. It included questions regarding symptoms patients experienced after a treatment including manual therapy and perceived as adverse. Poisson and negative binomial regression were used to determine factors associated with the number of symptoms that patients experienced and perceived as adverse. Results: Symptoms that affected patient's functionality were most often perceived as AR. The neck region was the body part with the greatest number of perceived AR (n = 83). Patients with neck pain who agreed that education may change their experience with AR had a lower incidence rate of AR. Conclusion: Findings indicate that communication regarding post-treatment symptoms between clinicians and patients is important and can potentially influence patients' perception of post-treatment symptoms.

Mixed-method investigation of health consumers' perception and experience of participation in patient safety activities

OBJECTIVES

This study aimed to examine the factors influencing patient safety behaviours and to explore health customers' experiences of patient participation in the healthcare system.

DESIGN

A mixed-method sequential explanatory design was employed using a survey and focus group interviews with health consumers.

SETTING

The study was conducted in South Korea using an online survey tool.

PARTICIPANTS

Survey data were collected from 493 Korean adults, aged 19 years or older, who had visited hospitals within the most recent 1 year. Focus group interviews were conducted in two groups of six participants each among those of the survey participants who agreed to participate in focus groups.

MAIN OUTCOME MEASURES

The survey measured the recognition of the importance of participation, extent of willingness to participate and experience of engaging in patient safety activities using a 4-point Likert scale. Qualitative data were collected through focus group interviews to explore health consumers' experience of patient participation in hospital care, and the data were analysed using content analysis.

RESULTS

The average score for experience of participation in patient safety behaviours (2.13±0.63) was found to be lower than those of recognition of the importance of participation (3.27±0.51) and willingness to participate (2.62±0.52). By integrating the results of the quantitative and qualitative data analysis, the factors associated with the experience of engaging in healthcare behaviour included patient-related factors, illness-related factors, factors involving relationship between patients and healthcare providers, and healthcare environment factors.

CONCLUSIONS

To improve patient participation, it is necessary to create a healthcare environment in which patients can speak comfortably and to provide an education programme reflecting the patients' needs. Also, healthcare providers must consider patients as partners for patient safety. Shared decision-making procedures and patient-centred care and patient safety policies should be established in hospitals.

Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: A qualitative study

Aim

To investigate barriers to patient engagement in the delivery of safe hospital care.

Design

Qualitative exploratory study.

Methods

A qualitative study with 35 Iranian health professionals was conducted from February to April 2019 using semi-structured interviews to elicit their opinions. MAXQDA 11 software was used for data management, and the data were analysed using framework analysis.

Results

Barriers, which potentially have negative impact on patient engagement in the delivery of safer care, were categorized into four themes. The first category included patient-related barriers such as low levels of health literacy, ineffective education, patient unwillingness and cultural barriers. The second category included staff-related barriers such as the existence of negative attitudes towards engaging patients in matters relating to patient safety, ineffective communication, high workload and the reluctance on the part of physicians to engage with patients. Barriers created by limited resources and inadequate training provided by universities and in the workplace formed the third category and community-related barriers such as the inadequate dissemination of information via the mass media and a lack of community-based services formed the fourth category.

Conclusion

Results demonstrate the multilayered nature of the significant barriers to the engagement of patients in the delivery of safe care and reflect the need for a collaborative approach between the recipients of care, researchers, care providers and policy makers if these are to be overcome.

Can patients contribute to safer care in meetings with healthcare professionals? A crosssectional survey of patient perceptions and beliefs

OBJECTIVES

To investigate patients' perceptions of their meetings with healthcare professionals and the extent to which they believe they can influence patient safety in these meetings.

DESIGN

Cross-sectional survey of patients using a study-specific questionnaire. Data were analysed using both parametric and non-parametric statistics.

SETTING

The study was conducted in primary and secondary care in three county councils in southeast Sweden by means of a survey questionnaire despatched in January 2017.

PARTICIPANTS

Survey data were collected from 1445 patients, 333 of whom were complainants (patients who had filed a complaint about being harmed in healthcare) and 1112 regular patients (patients recruited from healthcare units).

MAIN OUTCOME MEASURES

Patients' perceptions of meetings with physicians and nurses, beliefs concerning patients' contributions to safer care and whether the patients had suffered harm in healthcare during the past 10 years.

RESULTS

Most respondents reported that it was easy to ask physicians and nurses questions (84.9% and 86.6%) and to point out if something felt odd in their care (77.7% and 80.7%). In general, complainants agreed to a higher extent compared with regular patients that patients can contribute to safer care (mean 1.92 and 2.13, p<0.001). Almost one-third (31.2%) of the respondents (both complainants and regular patients) reported that they had suffered harm in healthcare during the past 10 years.

CONCLUSIONS

Most respondents believed that healthcare professionals can facilitate patient interaction and increase patient safety by encouraging patients to ask questions and take an active part in their care. Further research will need to identify strategies to support such questioning in routine practice and ensure that it achieves its intended goals.

Healthcare staff's views on the patients' prerequisites to be co-creator in preventing healthcare-associated infections

Background

Every year, patients are affected by suffering and death caused by adverse events in connection with health care and the most common adverse events are healthcare‐associated infections (HAI). The Swedish Patient Act from 2015 strengthens the patient's position in health care; however, there is lack of knowledge of how healthcare staff experience the possibilities to make the patient involved in the preventive work of HAI.

Aim

To describe healthcare professionals' views on the patient's prerequisites to be co‐creator in preventing HAI in connection with hospital care.

Method

This study had a qualitative descriptive design with semi‐structured individual interviews. Qualitative inductive content analysis was used to analyse the transcribed interview data. The study setting was a hospital in Sweden in 2015. Interviews were carried out among six healthcare professionals.

Results

In the analysis, 5 themes and 14 categories were identified in three different domains: Organisation, Healthcare staff and Patient. The result indicates an obstacle in each domain for the patient to become co‐creator in preventing HAI. In Organisation domain, a lack of organizational structure such as elaborated working methods to involve the patient was pointed out. In the domain Healthcare staff, it showed that the professionals allocate the responsibility of preventing HAI to the patient but only if they had to or if they trusted the patient. In the Patient domain, the result states that the patient was perceived as passive; they did not take own initiatives to get involved.

Conclusion

The patient has an important role in successful HAI prevention work and should be considered as an obvious co‐creator. Nevertheless, this study shows that neither organisation nor healthcare staff are sufficiently prepared for this. The organisation must make an anchored, structured and systematic work centred on the patient's needs and give more support both to healthcare professionals and patients.

Why are patients not more involved in their own safety? A questionnaire-based survey in a multi-ethnic North London hospital population

PURPOSE

Active patient participation in safety pathways has demonstrated benefits in reducing preventable errors, especially in relation to hand hygiene and surgical site marking. The authors sought to examine patient participation in a range of safety-related behaviours as well as factors that influence this, such as gender, education, age and language.

DESIGN

A 20-point questionnaire was employed in a London teaching hospital to explore safety-related behaviours, particularly assessing patient's willingness to challenge healthcare professionals and engagement in taking an active role in their own care while in hospital. Data was also collected on participant demographic details including gender, age, ethnicity, English language proficiency and education status.

RESULTS

85% of the 175 patients surveyed would consider bringing a list of their medications to hospital, but only 60% would bring a list of previous surgeries. Only 45% would actively engage in the WHO Safer Surgery Checklist and over three quarters (80%) would not challenge doctors and nurses regarding hand hygiene, believing that they would cause offence. Female patients who had tertiary education, were fluent in English and less than 60 years of age were statistically more likely to feel responsible for their own safety and take an active role in safety-related behaviour while in hospital (p<0.05).

CONCLUSIONS

Many patients are not engaged in safety-related behaviour and do not challenge healthcare professionals on safety issues. Older male patients who were not tertiary educated or fluent in English need to be empowered to take an active role in such behaviour. Further research is required to investigate how to achieve this.

A pesquisa em saúde no Brasil: desafios a enfrentar

RESUMO O ensaio apresenta reflexões sobre o quanto a pesquisa e o desenvolvimento são capazes de promover um ciclo virtuoso nos sistemas universais de saúde, como o Sistema Único de Saúde (SUS), dotando-os de ciência para a tomada de decisão e de propostas inovadoras, quando consideradas as opiniões de seus usuários. A partir das demandas por 'pesquisa' expostas no relatório final da VIII Conferência Nacional de Saúde, apresenta o cenário atual da pesquisa no Brasil, com ênfase na insuficiência do financiamento e na lacuna entre a produção científica e as práticas em saúde. Conclui apresentando os desafios que devem ser transpostos pelos pesquisadores em saúde para inserir os brasileiros, suas realidades e capacidades na geração de mudança e inovação para o SUS, na redução de desigualdades sociais, a partir de debates sobre o futuro dos sistemas universais.

Problems with incident reporting: Reports lead rarely to recommendations

AIM AND OBJECTIVE

To analyse trends in incident reporting over the last 5 years and determine how many reports led to recommendations?

BACKGROUND

Patient safety incident reporting systems have been used in health care for years. However, they have a significant weakness in that reports often do not lead to any visible action.

DESIGN

The study is a retrospective register study. STROBE checklist was applied in the preparation of the paper.

METHODS

Data were collected from a web-based incident reporting database (HaiPro) for a social- and healthcare organisation in Finland, covering the period from 2011-2015.

RESULTS

In total, 16,019 incident reports were analysed. In 2.7% (n = 426) of all reports, there was written recommendation to develop action that such incidents would not happen again. Those reports were classified into seven categories: education, introduction and information, introduction to work, patient care, guidelines, instruments and IT programmes, and the physical environment.

CONCLUSIONS

Managers get major amount incident reports. There should be (a) a definition what kind of events should be reported, (b) a definition for how serious events managers have to make a recommendation and (c) control that recommendations are implemented.

RELEVANCE TO CLINICAL PRACTICE

There is a need for more action to promote patient safety based on incident reports.

Patient participation in patient safety-An exploration of promoting factors

AIMS

To study how internal medicine patients experienced patient safety during their recent periods of care and to identify explanatory factors for patient participation.

BACKGROUND

Patient participation is recognized as one of the main factors promoting quality and safety and the identification of effective interventions that encourage safe care.

METHODS

A cross-sectional survey of patients (n = 462) in the internal medicine wards (n = 18) of all five Finnish university hospitals. Data were analysed using principal component analysis and multiple linear regression.

RESULTS

Most patients (78%) assessed the level of patient safety on their ward as "very good" or "excellent," 20% of patients assessed it as acceptable or worse. The following were considered to be the most important factors explaining higher patient participation: informing patients about the research and encouraging them to participate (β = 0.378, p < 0.001), providing necessary information promptly and comprehensibly (β = 0.393, p < 0.001), and enhancing patients' ability to identify patient safety incident(s) (β = 0.186, p < 0.001).

CONCLUSIONS

Healthcare workers must improve by encouraging patient participation and providing relevant information to patients.

IMPLICATION FOR NURSING MANAGEMENT

Nursing leaders must be competent to support, lead, and allocate resources for the creation of an environment where patient participation can occur and is valued by health care workers.

Person-centered endoscopy safety checklist: Development, implementation, and evaluation

AIM

To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.

METHODS

The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.

RESULTS

A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.

CONCLUSION

The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.

Measuring patient safety culture in maternal and child health institutions in China: a qualitative study

INTRODUCTION

Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients.

OBJECTIVES

This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China.

METHODS

The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes.

RESULTS

The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC.

CONCLUSIONS

Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of 'patient safety' goes beyond the traditional definition of patients. General well-being, health and disease prevention are important anchor points for defining PSC in such settings.