Predictors of hospitalized patients' intentions to prevent healthcare harm: a cross sectional survey

Factors influencing Patient engagement in preventing pressure injuries: A cross-sectional study in Orthopedic inpatients

AIM

This study aimed to explore the level of patients' engagement behaviours in preventing pressure injury (PI) and the influencing factors related to it.

BACKGROUND

The importance of "Patient and Family Engagement" was recognized as one of the key components in the outline of the 2023 Global Patient Safety Report. PIs were common and concerning patient safety events in Orthopaedics department. Active patient participation behaviour can effectively prevent the occurrence of PIs.

METHOD

This was a cross-sectional study involving 366 participants from Orthopaedics in China who has high level of risk in PI. The behavioural level of patients' participation in PI prevention was measured using a research tool designed by the research team. Based on the theory of planned behaviour, the possible influencing factors were determined, and the corresponding research tools were selected for evaluation. Univariate analysis, correlation analysis and multiple stepwise regression were used to determine the influencing factors of patients' participation behaviour with SPSS 25.0.

RESULTS

The total score of orthopaedic inpatients participating in PI preventive behaviour was 89.45 ± 10.64, with a scoring rate of 85.19 % (actual score/maximum possible score × 100 %), indicating relatively high adherence. Multiple regression analysis revealed that social support showed the strongest positive association (β = 0.291, P < 0.001), suggesting enhanced support networks facilitate engagement. Participation attitude (β = 0.211, P < 0.001) and health literacy (β = 0.233, P < 0.001) were key cognitive facilitators. Unexpectedly, cohabitation with children exhibited negative correlation (β = -0.141, P = 0.001), potentially indicating caregiving role transfer. Inter-hospital transfers (β = -0.120, P = 0.004) and medium-length stays (4-7 days, β = -0.089, P = 0.010) were inversely related, possibly reflecting care continuity challenges. Social Security recipients demonstrated greater participation (β = 0.108, P = 0.009), highlighting socioeconomic influences.

CONCLUSION

Our findings may guide clinical healthcare providers to develop more targeted interventions to promote patient engagement in self-care, including encouraging family members to involve in PI prevention with patients, improving patients' attitude of participation, and supporting more health education of PI prevention. It was a potential suggestion for patient participation behaviour in medical services to prevent other types of adverse events as well.

From identifying patient safety risks to reporting patient complaints: A grounded theory study on patients' hospital experiences

AIM

To explore how patients with hospital experience construct patient safety, from the identification of a patient safety risk to the decision to file a complaint.

BACKGROUND

Patients play an important role in the prevention of adverse events in hospitals, but the ability of patients to act and influence their own safety is still challenged by multiple factors. Understanding how patients perceive risk and act to prevent harm may shed light on how to enhance patients' opportunities to participate in patient safety.

DESIGN

The research design of this study is qualitative and exploratory.

METHODS

Twelve participants who had experienced Swedish hospital care were interviewed between June 2022 and July 2023. The method of analysis was constructivist grounded theory, focusing on social processes. The COREQ checklist for qualitative research was followed.

RESULTS

Four categories were constructed: (1) defining the boundary between one's own capacity and that of the hospital, (2) acting to minimize the impact on one's safety, (3) finding oneself in the hands of healthcare professionals and (4) exploring the boundaries between normality and abnormality of the situation. This process was captured in the core category of navigating the path of least suffering. This illustrated how the participants constructed meaning about patient safety risks and showed that they prevented multiple adverse events.

CONCLUSIONS

Provided that participants were able to act independently, they avoided a multitude of adverse events. When they were dependent on healthcare professionals, their safety became more vulnerable. Failure to respond to the participants' concerns could lead to long-term suffering.

RELEVANCE TO CLINICAL PRACTICE

By responding immediately to patients' concerns about their safety, healthcare professionals can help prevent avoidable suffering and exhaustive searching for someone in the healthcare system who will take their needs seriously.

PATIENT CONTRIBUTION

A member check was performed with the help of one of the participants who read the findings to confirm familiarity.

Struggling for access to appropriate healthcare services: A qualitative content analysis of patient complaints

AIM

This study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting.

DESIGN

This study used a qualitative descriptive design and was conducted at a Swedish university hospital.

METHOD

The 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis.

RESULTS

The overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients' and relatives' needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs.

CONCLUSION

Patients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients' needs were met. This restriction of access risked the deterioration of patient health and safety.

IMPACT

Patients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital-associated settings.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Questionnaires Measuring Patient Participation in Patient Safety-a systematic review

AIM

The purpose of this review was to evaluate the content, validity and reliability of patient-reported questionnaires on patient participation in patient safety.

BACKGROUND

Patient participation in patient safety is one of the key strategies that are increasingly regarded as a critical intervention to improve the quality of safety care.

EVALUATION

A systematic review was conducted according to PRISMA guidelines. The content, reliability and validity of patient-reported questionnaires on patient participation in patient safety were assessed.

KEY ISSUES

Twenty-seven studies were included for data extraction and synthesis. The questionnaire contents most commonly used to describe patient participation in patient safety were 'attitudes and perceptions', 'experience', 'information and feedback' and 'willingness'. Internal consistency was evaluated for seventeen questionnaires, and test-retest reliability was tested for four questionnaires. Content validity was assessed among all included questionnaires, and structural validity was evaluated for twelve questionnaires.

CONCLUSIONS

Future research targeting the different safety issues is still indispensable for developing patient-reported questionnaires with great psychometric quality in validity, reliability, feasibility and usability in patient participation in patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical nurses should consider the internal consistency, test-retest reliability, content validity and structural validity of the questionnaires that have been positively appraised for methodological quality before use.

Research on the factors that influence patients with colorectal cancer participating in the prevention and control of surgical site infection: Based on the extended theory of planned behaviour

Background

The most common and severe type of nosocomial infection in patients with colorectal cancer is surgical site infection (SSI). Patient‐related factors are an important components of SSI. So it is necessary to participate in SSI prevention and control. It is important to identify the factors that influence patients' participation behaviour and to explore the mechanism of these effects.

Methods

A total of 580 patients with colorectal cancer completed relevant measures. Based on the extended theory of planned behaviour, a structural equation model was used to analyse the relationship among the influencing factors.

Results

The factors influencing participation of patients with colorectal cancer in SSI prevention and control were participation intention, participation ability, self‐efficacy, participation attitude, perceived medical staff support, trust in physicians and social support. The direct effect coefficients of participation intention, participation ability and physician trust on SSI prevention and control behaviour were 0.67, 0.21 and 0.11, respectively. Self‐efficacy, participation attitude, perceived medical staff support and social support indirectly affect participation behaviour through participation intention, and their effect values are 0.21, 0.11, 0.11 and 0.08, respectively.

Conclusions

Based on the structural equation model developed in this study, targeted intervention measures should be implemented to mobilize the intention and enthusiasm of patients with colorectal cancer to participate in the prevention and control of SSI.

Patient or Public Contribution

Patients or public contribute to spreading research findings, and promote broad participation in the implementation of policies or strategies.

A qualitative study of nurse-patient communication and information provision during surgical pre-admission clinics

Background

Health‐care service users are often being described as ‘co‐producers’ with an active role in their care. However, there are challenges associated with this approach, including how standardization affects personalized care, and the ability of patients to retain high volumes of information.

Objective

Our study explores patient and nursing perspectives of information provision in the pre‐admission element of an Enhanced Recovery After Surgery programme, an evidence‐based approach implemented to improve the quality of surgical care. Our analysis has been informed by an evidence‐based model developed by Grande et al Patient Educ Couns. 2014;95:281.

Design/Setting and participants

This was a qualitative study including observations of pre‐admission clinics and semi‐structured interviews across three surgical wards. Patients (n = 21) and registered nurses (n = 21) were purposively selected for interviews.

Results

Patients welcomed the opportunity for active involvement in their care. However, we also identified informational boundaries and how illness and treatment‐related anxieties were barriers to patient engagement with the information provided.

Discussion

We recommend that to support a patient‐centred and individualized approach to patient involvement the ‘information (giving) + activation’ element of Grande et al Patient Educ Couns. 2014;95:281 model be reconfigured to allow for ‘information (giving) + exploration +activation’.

Conclusion

Nurses need to feel empowered to adopt strategies that allow for different informational needs, rather than adopting a one‐size‐fits‐all paternalistic approach.

Patient contribution

This study focused on patient involvement and we give thanks to all the patients who took part in interviews and those who allowed us to observe their care.

Scoping review of patients' attitudes about their role and behaviours to ensure safe care at the direct care level

BACKGROUND

To improve harm prevention, patient engagement in safety at the direct care level is advocated. For patient safety to most effectively include patients, it is critical to reflect on existing evidence, to better position future research with implications for education and practice.

METHODS

As part of a multi-phase study, which included a qualitative descriptive study (Duhn & Medves, 2018), a scoping review about patient engagement in safety was conducted. The objective was to review papers about patients' attitudes and behaviours concerning their involvement in ensuring their safe care. The databases searched included MEDLINE, CINAHL and EMBASE (year ending 2019).

RESULTS

This review included 35 papers about "Patient Attitudes" and 125 papers about "Patient Behaviours"-indicative of growing global interest in this field. Several patterns emerged from the review, including that most investigators have focused on a particular dimension of harm prevention, such as asking about provider handwashing, and there is less known about patients' opinions about their role in safety generally and how to actualize it in a way that is right for them. While patients may indicate favourable attitudes toward safety involvement generally, intention to act or actual behaviours may be quite different.

CONCLUSION

This review, given its multi-focus across the continuum of care, is the first of its kind based on existing literature. It provides an important international "mapping" of the initiatives that are underway to engage patients in different elements of safety and their viewpoints, and identifies the gaps that remain.

Patient and family engagement as a potential approach for improving patient safety: A systematic review

AIMS

To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.

BACKGROUND

Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.

DESIGN

Mixed method multilevel synthesis.

DATA SOURCES

PubMed, CINAHL, Embase, and Cochrance Library (January 2009-April 2018).

REVIEW METHODS

The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.

RESULTS

Forty-two relevant studies were identified. Common intervention groups included 'direct care' and 'organization' levels with 'consultation' and 'involvement' approaches, while the 'health system' level and 'partnership and shared leadership' approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.

CONCLUSION

Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.

IMPACT

Policymakers should issue guidelines for implementing patient and family engagement in healthcare systems which would enable healthcare providers to implement patient and family engagement and improve patient safety appropriately and effectively.

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.

The Relationship Between Patients' Safety-Related Behaviors and Safety Events and Patient Experiences in Korean Hospitals

BACKGROUND AND PURPOSE

There is increasing interest in patient participation in healthcare aimed at enhancing safety. The purposes of this study were to examine levels of patients' safety-related behaviors and to determine their relationships with safety events and care experiences.

METHODS

A cross-sectional survey was conducted with 360 patients in two tertiary general hospitals in Korea. The final dataset consisted of 341 patient responses. A questionnaire was developed to collect information concerning patients' safety-related behaviors, care experiences, and the occurrence of safety events. Univariate and multivariate analyses were performed.

RESULTS

On average, patients participated in 10.0 (SD 5.4) safety-related behaviors. Sixty-five (19.1%) patients reported experiencing at least one adverse event related to medical management. The mean problem score for care experience was 39.4 (SD 27.8) out of 100.0. Multiple logistic analysis showed that patients with adequate health literacy and higher activation levels were more likely to have high safety-related behavior participation levels. High participation in safety-related behaviors was negatively associated with the occurrence of safety events. However, no significant relationship was found between patient participation and the total problem scores for care experience.

IMPLICATIONS FOR PRACTICE

These findings suggest that efforts to support patients with limited health literacy and low activation levels are needed to facilitate patient participation. Active participation in safety-related behaviors can contribute to improving patient safety.

Improving patient safety through the involvement of patients: development and evaluation of novel interventions to engage patients in preventing patient safety incidents and protecting them against unintended harm

Background

Estimates suggest that, in NHS hospitals, incidents causing harm to patients occur in 10% of admissions, with costs to the NHS of > £2B. About one-third of harmful events are believed to be preventable. Strategies to reduce patient safety incidents (PSIs) have mostly focused on changing systems of care and professional behaviour, with the role that patients can play in enhancing the safety of care being relatively unexplored. However, although the role and effectiveness of patient involvement in safety initiatives is unclear, previous work has identified a general willingness among patients to contribute to initiatives to improve health-care safety.

Aim

Our aim in this programme was to design, develop and evaluate four innovative approaches to engage patients in preventing PSIs: assessing risk, reporting incidents, direct engagement in preventing harm and education and training.

Methods and results

We developed tools to report PSIs [patient incident reporting tool (PIRT)] and provide feedback on factors that might contribute to PSIs in the future [Patient Measure of Safety (PMOS)]. These were combined into a single instrument and evaluated in the Patient Reporting and Action for a Safe Environment (PRASE) intervention using a randomised design. Although take-up of the intervention by, and retention of, participating hospital wards was 100% and patient participation was high at 86%, compliance with the intervention, particularly the implementation of action plans, was poor. We found no significant effect of the intervention on outcomes at 6 or 12 months. The ThinkSAFE project involved the development and evaluation of an intervention to support patients to directly engage with health-care staff to enhance their safety through strategies such as checking their care and speaking up to staff if they had any concerns. The piloting of ThinkSAFE showed that the approach is feasible and acceptable to users and may have the potential to improve patient safety. We also developed a patient safety training programme for junior doctors based on patients who had experienced PSIs recounting their own stories. This approach was compared with traditional methods of patient safety teaching in a randomised controlled trial. The study showed that delivering patient safety training based on patient narratives is feasible and had an effect on emotional engagement and learning about communication. However, there was no effect on changing general attitudes to safety compared with the control.

Conclusion

This research programme has developed a number of novel interventions to engage patients in preventing PSIs and protecting them against unintended harm. In our evaluations of these interventions we have been unable to demonstrate any improvement in patient safety although this conclusion comes with a number of caveats, mainly about the difficulty of measuring patient safety outcomes. Reflecting this difficulty, one of our recommendations for future research is to develop reliable and valid measures to help efficiently evaluate safety improvement interventions. The programme found patients to be willing to codesign, coproduce and participate in initiatives to prevent PSIs and the approaches used were feasible and acceptable. These factors together with recent calls to strengthen the patient voice in health care could suggest that the tools and interventions from this programme would benefit from further development and evaluation.

Trial registration

Current Controlled Trials ISRCTN07689702.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Effect of Motivational Interviewing on a Weight Loss Program Based on the Protection Motivation Theory

Background:

The prevalence of overweight and obesity is on the increase the world over, which imposes an ever-increasing burden on societies and health care systems.

Objectives:

This study sought to investigate the effect of motivational interviewing (MI) on a weight-loss program based on the protection motivation theory (PMT).

Patients and Methods:

This randomized clinical trial study, comprising pretest-posttest with a control group, was conducted on 150 overweight and obese women attending a private nutrition clinic for the first time. Samples were randomly selected using the clinic’s records and then allocated to three groups (50 women in each group) receiving: 1) a standard weight-control program; 2) motivational interviewing; and 3) MI plus intention intervention. Data were collected using a researcher-made questionnaire through in-person interviews and were analyzed using SPSS (version 11) and statistical tests, including the Kruskal-Wallis test, one-way analysis of variance, paired t-test, and linear regression model.

Results:

In the two intervention groups, the PMT construct scores, namely susceptibility (P = 0.001), severity (P = 0.001), rewards (P =0.004), self-efficacy (P = 0.001), response efficacy (P = 0.001), and costs (P = 0.014), were significantly increased compared to those in the control group. The anthropometric status was statistically significant in the MI group (P = 0.001) and the MI plus intention-intervention group (P = 0.001) at 2 months’ follow-up, while in the control group, weight was meaningfully different after the intervention (P = 0.027). Weight was different between the groups after the intervention, with the Tukey test demonstrating that the differences were statistically significant between the control group and the MI group.

Conclusions:

Our results demonstrated that MI, combined with the implementation of intention intervention, increased weight loss and PMT construct scores in our study population.

Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene

BACKGROUND

Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands.

AIM

To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH.

METHODS

A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013.

FINDINGS

Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak.

CONCLUSION

A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.

Patient participation in patient safety and nursing input - a systematic review

AIMS AND OBJECTIVES

This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives.

BACKGROUND

Ambiguities remain about how patients participate in routine measures designed to promote patient safety.

DESIGN

Systematic review using integrative methods.

METHODS

Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management".

RESULTS

We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives.

CONCLUSIONS

Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures.

RELEVANCE TO CLINICAL PRACTICE

Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety.

Predictors of health care professionals' attitudes towards involvement in safety-relevant behaviours

BACKGROUND

Patients can make valuable contributions towards promoting the safety of their health care. Health care professionals (HCPs) could play an important role in encouraging patient involvement in safety-relevant behaviours. However, to date factors that determine HCPs' attitudes towards patient participation in this area remain largely unexplored.

OBJECTIVE

To investigate predictors of HCPs' attitudes towards patient involvement in safety-relevant behaviours.

DESIGN

A 22-item cross-sectional fractional factorial survey that assessed HCPs' attitudes towards patient involvement in relation to two error scenarios relating to hand hygiene and medication safety.

SETTING

Four hospitals in London

PARTICIPANTS

  Two hundred sixteen HCPs (116 doctors; 100 nurses) aged between 21 and 60 years (mean: 32): 129 female.

OUTCOME MEASURES

Approval of patient's behaviour, HCP response to the patient, anticipated effects on the patient-HCP relationship, support for being asked as a HCP, affective rating response to the vignettes.

RESULTS

HCPs elicited more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Across vignettes and error scenarios, the strongest predictors of attitudes were how the patient intervened and how the HCP responded to the patient's behaviour. With regard to HCP characteristics, doctors viewed patients intervening less favourably than nurses.

CONCLUSIONS

HCPs perceive patients intervening about a potential error less favourably if the patient's behaviour is confrontational in nature or if the HCP responds to the patient intervening in a discouraging manner. In particular, if a HCP responds negatively to the patient (irrespective of whether an error actually occurred), this is perceived as having negative effects on the HCP-patient relationship.

Seeing it from both sides: do approaches to involving patients in improving their safety risk damaging the trust between patients and healthcare professionals? An interview study

OBJECTIVE

Encouraging patients to be more vigilant about their care challenges the traditional dynamics of patient-healthcare professional interactions. This study aimed to explore, from the perspectives of both patients and frontline healthcare staff, the potential consequences of patient-mediated intervention as a way of pushing safety improvement through the involvement of patients.

DESIGN

Qualitative study, using purposive sampling and semi-structured interviews with patients, their relatives and healthcare professionals. Emergent themes were identified using grounded theory, with data coded using NVIVO 8.

PARTICIPANTS

16 patients, 4 relatives, (mean age (sd) 60 years (15); 12 female, 8 male) and 39 healthcare professionals, (9 pharmacists, 11 doctors, 12 nurses, 7 health care assistants).

SETTING

Participants were sampled from general medical and surgical wards, taking acute and elective admissions, in two hospitals in north east England.

RESULTS

Positive consequences were identified but some actions encouraged by current patient-mediated approaches elicited feelings of suspicion and mistrust. For example, patients felt speaking up might appear rude or disrespectful, were concerned about upsetting staff and worried that their care might be compromised. Staff, whilst apparently welcoming patient questions, appeared uncertain about patients' motives for questioning and believed that patients who asked many questions and/or who wrote things down were preparing to complain. Behavioural implications were identified that could serve to exacerbate patient safety problems (e.g. staff avoiding contact with inquisitive patients or relatives; patients avoiding contact with unreceptive staff).

CONCLUSIONS

Approaches that aim to push improvement in patient safety through the involvement of patients could engender mistrust and create negative tensions in the patient-provider relationship. A more collaborative approach, that encourages patients and healthcare staff to work together, is needed. Future initiatives should aim to shift the current focus away from "checking up" on individual healthcare professionals to one that engages both parties in the common goal of enhancing safety.

The medical student as a patient: attitudes towards involvement in the quality and safety of health care

BACKGROUND

In recent years, factors that affect patients' willingness and ability to participate in safety-relevant behaviours have been investigated. However, how trained healthcare professionals or medical students would feel participating in safety-relevant behaviours as a patient in hospital remains largely unexplored.

OBJECTIVES

To investigate medical students' willingness to participate in behaviours related to the quality and safety of their health care.

DESIGN

A cross-sectional exploratory study using a survey that addressed willingness to participate in different behaviours recommended by current patient safety initiatives. Three types of interactional behaviours (asking factual or challenging questions, notifying doctors or nurses of errors/problems) and three non-interactional behaviours (choosing a hospital based on the safety record, bringing medicines and a list of allergies into hospital, and reporting an error to a national reporting system) were assessed.

PARTICIPANTS

One hundred and seventy-nine medical students from an inner city London teaching hospital participated in the study.

FINDINGS

Students' willingness to participate was affected (P < 0.05) by the action required by the patient and (for interactional behaviours) whether the patient was engaging in the specific action with a doctor or nurse. Students were least willing to ask 'challenging' questions to doctors and nurses and to report errors to a national reporting system. Doctors' and nurses' encouragement appeared to increase self-reported willingness to participate in behaviours where baseline willingness was low.

CONCLUSION

Similar to research on lay patient populations; medical students do not view involvement in safety-related behaviours equally. Interventions should be tailored at encouraging students to participate in behaviours they are less inclined to take on an active role in. Future research is required to examine students' motivations for participation in this important but heavily under-researched area.

A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention

BACKGROUND

Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours.

OBJECTIVE

To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error.

DESIGN

Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient.

SETTING

Twelve hospitals in Switzerland.

PARTICIPANTS

A total of 1141 HCPs (response rate 45%).

MEASUREMENTS

Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient-HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales.

RESULTS

Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient-HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation.

CONCLUSIONS

This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues.

A qualitative exploration of patients' attitudes towards the 'Participate Inform Notice Know' (PINK) patient safety video

OBJECTIVE

To explore patients' attitudes towards the PINK video, a patient education video aimed at encouraging hospital patients' involvement in safety-relevant behaviours.

DESIGN

Qualitative semi-structured interviews. Detailed field notes were taken during the interviews which were analysed using content analysis.

SETTING

One National Health System (NHS) teaching hospital based in London, UK.

PARTICIPANTS

Thirty-six in-patients aged between 20 and 79 years, 18 of them males.

INTERVENTION

The PINK video is a short animated educational video aimed at encouraging patients to be involved in the safety of their care during hospitalization.

MAIN OUTCOME MEASURES

Patients' perceptions of how informative, relevant and acceptable the video is; attitudes towards participating in the recommended safety-related behaviours and; potential negative side effects of watching the video.

RESULTS

Overall the video was received favourably among the interviewees. Commonly cited benefits included raising awareness and facilitating patients to be involved in their care during their hospital stay. More variability was found in participants' views with regard to the video's role as a patient safety enhancement tool. A number of suggestions for improvement of the video were provided relating to tailoring its content and design to meet the needs of individual patients and their circumstances.

CONCLUSIONS

Educational videos such as PINK have significant potential to empower patients in the safety and quality of their care. However, efforts to implement patient safety educational videos in practice need to consider different patient groups' needs and characteristics instead of trying to adopt 'a one size fits all' approach.