An Examination of Opportunities for the Active Patient in Improving Patient Safety

Clinical Safety Research Unit, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
Journal of Patient Safety (Impact Factor: 1.49). 03/2012; 8(1):36-43. DOI: 10.1097/PTS.0b013e31823cba94
Source: PubMed


Patients can make valuable contributions to their health care safety. Little is known, however, about the factors that could affect patient participation in safety-related aspects of their health care management. Examining and understanding how patient involvement in safety-related behaviors can be conceptualized will allow greater insight into why patients may be more willing to participate in some behaviors more than others may.
This study aimed to develop a new approach for understanding and conceptualizing patient involvement in safety with specific reference to a surgical patient cohort.
The authors conducted a review of the key opportunities for patient involvement along the surgical care trajectory and examination and identification of the properties and characteristics of different safety-related behaviors and the barriers to patient involvement they entail.
Safety-related behaviors comprise 3 main properties including the type of error the behavior is trying to prevent (e.g., medication error), the action required by the patient (e.g., asking questions), and the characteristics of the action (e.g., whether the behavior involves interacting with a health care professional). Barriers to patient involvement that relate to patients and health care professionals can be broadly categorized as interpersonal, intrapersonal, and cultural.
We believe that thinking of patient involvement in safety relating to properties and characteristics of the behavior together with the barriers to involvement could aid the design, implementation, and evaluation of interventions aimed at encouraging patient participation. It will also enable a greater understanding and assessment of not only what interventions may be effective (at encouraging patient involvement) but when they might be effective (i.e., what stage of the care pathway) and why.

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    • "The medical and legal professions have defined the best practices and standards for obtaining the IC [1]. Moreover, the patient's involvement, and this clearly begins with adequate IC procedures, can in turn improve the patients' safety and quality of healthcare delivery [2]. From 1990's to 2004 the rights of patients in Croatia were regulated by several laws that defined general concept of the IC. "
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    ABSTRACT: Background: The informed consent, if obtained properly, can bring additional value to the physician-patient relationship and in many cases to the patients' safety. The previous research studies done in Croatia show the formality of the process of informed consent which often lacks quality and substance, as well as the poor knowledge of patients' rights. Therefore, the authors sought to elucidate the main issues related to the experience and assess the knowledge of general patient population about informed consent after several years of application of the Act on Protection of Patients' Rights. Methods: A short survey was conducted using an independently created questionnaire on a nationally representative sample of 1023 adult subjects divided into two groups: those who had been or not in a hospital for treatment in the past five years. Results: 60% of respondents had only partial knowledge of patients' rights. The level of knowledge about the informed consent was average but not in depth. 25% of respondents stated that they have received complete information during the informed consent procedure, and graded the level of the received information as high in nine percent of the cases. 15% of respondents could not remember whether they have signed or not an informed consent form. Conclusion: Based on the results obtained in our research there is need for improvement of the informed consent procedures and for further research in the issues surrounding the practices of informed consent in Croatia especially in the areas of quality and comprehension of the information, as well as the physician-patient decision-making process and education of physicians and general public.
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    • "Having a more coordinated approach to care transitions will ensure better care design and service planning for care transitions.1–5,8,14,24,25 Key to these efforts is having the responsibility of care coordination assigned to a professional or a team involved in the different levels of care.24 In the context of the current study, there was no point person who followed up or connected with the transferring patients once they were admitted to the CCC site. "
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    ABSTRACT: To explore patients' and family members' perspectives on how safety threats are detected and managed across care transitions and strategies that improve care transitions from acute care hospitals to complex continuing care and rehabilitation health care organizations. Poorly executed care transitions can result in additional health care spending due to adverse outcomes and delays as patients wait to transfer from acute care to facilities providing different levels of care. Patients and their families play an integral role in ensuring they receive safe care, as they are the one constant in care transitions processes. However, patients' and family members' perspectives on how safety threats are detected and managed across care transitions from health care facility to health care facility remain poorly understood. This qualitative study used semistructured interviews with patients (15) and family members (seven) who were transferred from an acute care hospital to a complex continuing care/rehabilitation care facility. Data were analyzed using a directed content analytical approach. OUR RESULTS REVEALED THREE KEY OVERARCHING THEMES IN THE PERCEPTIONS: lacking information, getting "funneled through" too soon, and difficulty adjusting to the shift from total care to almost self-care. Several patients and families described their expectations and experiences associated with their interfacility care transitions as being uninformed about their transfer or that transfer happened too early. In addition, study participants identified the need for having a coordinated approach to care transitions that engages patients and family members. Study findings provide patients' and family members' perspectives on key safety threats and how to improve care transitions. Of particular importance is the need for patients and family members to play a more active role in their care transition planning and self-care management.
    Full-text · Article · Oct 2012 · Patient Preference and Adherence
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    ABSTRACT: In the last decade, the field of patient safety has grappled with the complexity of health-care systems by attending to the activity of frontline clinicians. This article extends the field by highlighting the activity of patients and their carers in determining the safety of these systems. We draw on data from three studies exploring patients' accounts of their health-care experiences in Australia and internationally, to show how patients and carers are currently contributing to the safety of their own care. Furthermore, we emphasise the importance of patient-clinician collaboration in ensuring the success of these activities. We argue that it is no longer sufficient to discuss if patients should be involved with ensuring their own safety. Given that patients are already involved, we propose a new conceptualisation of safety and systems that acknowledges their involvement and supports patient-provider collaboration to achieve safer care.
    No preview · Article · Jan 2013 · Health
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