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Schlesinger M, Dhingra I, Fain BA, Prentice JC, Parkash V. Adverse events and perceived abandonment: learning from patients' accounts of medical mishaps. BMJ Open Qual 2024; 13:e002848. [PMID: 39147403 PMCID: PMC11331972 DOI: 10.1136/bmjoq-2024-002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/10/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed. OBJECTIVE To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment. METHODS Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt 'that the doctors abandoned or betrayed you or your family'. Open-ended responses were analysed with a coding schema by two clinician coders. RESULTS Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians. LIMITATIONS Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period. CONCLUSION Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians.
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Affiliation(s)
- Mark Schlesinger
- Yale University Yale School of Public Health, New Haven, Connecticut, USA
| | - Isha Dhingra
- Yale University Yale School of Public Health, New Haven, Connecticut, USA
| | - Barbara A Fain
- Betsy Lehman Center for Patient Safety, Boston, Massachusetts, USA
| | - Julia C Prentice
- Betsy Lehman Center for Patient Safety, Boston, Massachusetts, USA
| | - Vinita Parkash
- Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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Jiang Y, Hwang M, Cho Y, Friese CR, Hawley ST, Manojlovich M, Krauss JC, Gong Y. The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study. J Med Internet Res 2024; 26:e47685. [PMID: 38457204 PMCID: PMC10960221 DOI: 10.2196/47685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. OBJECTIVE We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. METHODS A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. RESULTS Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). CONCLUSIONS In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care.
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Affiliation(s)
- Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Misun Hwang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Christopher R Friese
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sarah T Hawley
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | | | - John C Krauss
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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3
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Groves PS, Bunch JL, Kuehnle F. Increasing a patient's sense of security in the hospital: A theory of trust and nursing action. Nurs Inq 2023; 30:e12569. [PMID: 37282711 DOI: 10.1111/nin.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/08/2023]
Abstract
Having a decreased sense of security leads to unnecessary suffering and distress for patients. Establishing trust is critical for nurses to promote a patient's sense of security, consistent with trauma-informed care. Research regarding nursing action, trust, and sense of security is wide-ranging but fragmented. We used theory synthesis to organize the disparate existing knowledge into a testable middle-range theory encompassing these concepts in hospitals. The resulting model illustrates how individuals are admitted to the hospital with some predisposition to trust or mistrust the healthcare system and/or personnel. Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering. Nurse action can ameliorate these effects by increasing a hospitalized person's sense of security or by promoting the development of interpersonal trust, also leading to an increased sense of security. Increased sense of security results in diminished anxiety and fear, and increased hopefulness, confidence, calm, sense of value, and sense of control. The consequences of a decreased sense of security are harmful to patients and nurses should know that they can intervene in ways that both increase interpersonal trust and sense of security.
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Affiliation(s)
| | - Jacinda L Bunch
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Francis Kuehnle
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Sutton E, Martin G, Eborall H, Tarrant C. Undertaking risk and relational work to manage vulnerability: Acute medical patients' involvement in patient safety in the NHS. Soc Sci Med 2023; 320:115729. [PMID: 36736055 DOI: 10.1016/j.socscimed.2023.115729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
Over the last decade a wealth of studies have explored the way that patients are involved in patient safety internationally. Most begin from the premise that patients can and should take on the role of identifying and reporting safety concerns. Most give little attention, however, to the impact of the patient's health status and vulnerability on their ability to participate in their safety. Drawing on qualitative interviews with 28 acute medical patients, this article aims to show how patients' contributions to their safety in the acute medical context are less about involvement as a deliberate intervention, and more about how patients manage their own vulnerability in their interactions with staff. Our analysis is underpinned by theories of vulnerability and risk. This enables us to provide a deeper understanding of how vulnerability shapes patients' involvement in their safety. Acute medical patients engage in reassurance-seeking, relational and vigilance work to manage their vulnerability. Patients undertake reassurance seeking to obtain evidence that they can trust the organisation and the professionals who work in it and relational and vigilance work to manage the vulnerability associated with dependence on others and the unpredictability of their status as acute medical patients. Patients are made responsible for speaking up about their care but simultaneously, by virtue of the expectations of the sick role and their relational vulnerability, encouraged to remain passive, compliant or silent. We show how risk frames the extent to which patients can activate their role in creating patient safety at the point of care. Foregrounding the theory of vulnerability, the concept of the sick role and the relationship of both to risk offers new insights into the potentials and limits of patient involvement in patient safety in the acute care context.
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Affiliation(s)
- E Sutton
- Department of Health Sciences, University of Leicester, UK.
| | - G Martin
- This. Institute, University of Cambridge, UK
| | | | - C Tarrant
- Department of Health Sciences, University of Leicester, UK
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5
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Alqenae FA, Steinke D, Carson-Stevens A, Keers RN. Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study. Ther Adv Drug Saf 2023; 14:20420986231154365. [PMID: 36949766 PMCID: PMC10026140 DOI: 10.1177/20420986231154365] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Improving medication safety during transition of care is an international healthcare priority. While existing research reveals that medication-related incidents and associated harms may be common following hospital discharge, there is limited information about their nature and contributory factors at a national level which is crucial to inform improvement strategy. Aim To characterise the nature and contributory factors of medication-related incidents during transition of care from secondary to primary care. Method A retrospective analysis of medication incidents reported to the National Reporting and Learning System (NRLS) in England and Wales between 2015 and 2019. Descriptive analysis identified the frequency and nature of incidents and content analysis of free text data, coded using the Patient Safety Research Group (PISA) classification, examined the contributory factors and outcome of incidents. Results A total of 1121 medication-related incident reports underwent analysis. Most incidents involved patients over 65 years old (55%, n = 626/1121). More than one in 10 (12.6%, n = 142/1121) incidents were associated with patient harm. The drug monitoring (17%) and administration stages (15%) were associated with a higher proportion of harmful incidents than any other drug use stages. Common medication classes associated with incidents were the cardiovascular (n = 734) and central nervous (n = 273) systems. Among 408 incidents reporting 467 contributory factors, the most common contributory factors were organisation factors (82%, n = 383/467) (mostly related to continuity of care which is the delivery of a seamless service through integration, co-ordination, and the sharing of information between different providers), followed by staff factors (16%, n = 75/467). Conclusion Medication incidents after hospital discharge are associated with patient harm. Several targets were identified for future research that could support the development of remedial interventions, including commonly observed medication classes, older adults, increase patient engagement, and improve shared care agreement for medication monitoring post hospital discharge. Plain language summary Study using reports about unsafe or substandard care mainly written by healthcare professionals to better understand the type and causes of medication safety problems following hospital discharge Why was the study done? The safe use of medicines after hospital discharge has been highlighted by the World Health Organization as an important target for improvement in patient care. Yet, the type of medication problems which occur, and their causes are poorly understood across England and Wales, which may hamper our efforts to create ways to improve care as they may not be based on what we know causes the problem in the first place.What did the researchers do? The research team studied medication safety incident reports collected across England and Wales over a 5-year period to better understand what kind of medication safety problems occur after hospital discharge and why they happen, so we can find ways to prevent them from happening in future.What did the researchers find? The total number of incident reports studied was 1121, and the majority (n = 626) involved older people. More than one in ten of these incidents caused harm to patients. The most common medications involved in the medication safety incidents were for cardiovascular diseases such as high blood pressure, conditions such as mental illness, pain and neurological conditions (e.g., epilepsy) and other illnesses such as diabetes. The most common causes of these incidents were because of the organisation rules, such as information sharing, followed by staff issues, such as not following protocols, individual mistakes and not having the right skills for the task.What do the findings mean? This study has identified some important targets that can be a focus of future efforts to improve the safe use of medicines after hospital discharge. These include concentrating attention on medication for the cardiovascular and central nervous systems (e.g., via incorporating them in prescribing safety indicators and pharmaceutical prioritisation tools), staff skill mix (e.g., embedding clinical pharmacist roles at key parts of the care pathway where greatest risk is suspected), and implementation of electronic interventions to improve timely communication of medication and other information between healthcare providers.
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Affiliation(s)
| | - Douglas Steinke
- Centre for Pharmacoepidemiology and Drug
Safety, Division of Pharmacy and Optometry, School of Health Sciences,
University of Manchester, Manchester, UK
- Pharmacy Department, Manchester University NHS
Foundation Trust, Manchester, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of
Medicine, Cardiff University, Cardiff, UK
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug
Safety, Division of Pharmacy and Optometry, School of Health Sciences,
University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater
Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Groves PS, Bunch JL, Hanrahan KM, Sabadosa KA, Sharp B, Williams JK. Patient Voices in Hospital Safety during the COVID-19 Pandemic. Clin Nurs Res 2023; 32:105-114. [PMID: 36250248 PMCID: PMC9577816 DOI: 10.1177/10547738221129711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hospitalized patients and their families may be reluctant to express safety concerns. We aimed to describe safety and quality concerns experienced by hospitalized patients and families and factors and outcomes surrounding decisions about voicing concerns, including those related to the COVID-19 pandemic. We conducted semi-structured interviews with 19 discharged inpatients or family members in a qualitative descriptive design. Some participants reported concern about staff competency or knowledge, communication and coordination, potential treatment errors, or care environment. Factors influencing feeling safe included healthcare team member characteristics, communication and coordination, and safe care expectations. Reasoning for voicing concerns often included personal characteristics. Reasons for not voicing concerns included feeling no action was needed or the concern was low priority. Outcomes for voicing a concern were categorized as resolved, disregarded, and unknown. These findings support the vital importance of open safety communication and trustworthy response to patients and family members who voice concerns.
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Affiliation(s)
| | | | - Kirsten M. Hanrahan
- University of Iowa, IA, USA
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Brittaney Sharp
- University of Iowa, IA, USA
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Shunmuga Sundaram C, Campbell R, Ju A, King MT, Rutherford C. Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies. J Patient Rep Outcomes 2022; 6:122. [PMID: 36459251 PMCID: PMC9718906 DOI: 10.1186/s41687-022-00524-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice. METHODS Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results. RESULTS Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors. CONCLUSION Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.
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Affiliation(s)
- Chindhu Shunmuga Sundaram
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Angela Ju
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
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8
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Pritchard D. Socially Extended Scientific Knowledge. Front Psychol 2022; 13:894738. [PMID: 35800928 PMCID: PMC9253682 DOI: 10.3389/fpsyg.2022.894738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
A three-tiered account of social cognition is set out-along with the corresponding variety of social knowledge that results from this social cognition-and applied to the special case of scientific collaboration. The first tier is socially-facilitated cognition, which results in socially-facilitated knowledge. This is a form of cognition which, while genuinely social (in that social factors play an important explanatory role in producing the target cognitive success), falls short of socially extended cognition. The second tier is socially extended cognition, which generates socially extended knowledge. This form of cognition is social in the specific sense of the information-processing of other agents forms part of the socially extended cognitive process at issue. It is argued, however, that the core notion of socially extended cognition is individual in nature, in that the target cognitive success is significantly creditable to the socially extended cognitive agency of the individual. Socially extended cognition, in its core sense, thus generates individual knowledge. Finally, there is distributed cognition, which generates distributed knowledge. This is where the cognitive successes produced by a research team are attributable to a group agent rather than to individuals within the team. Accordingly, where this form of social cognition generates knowledge (distributed knowledge), the knowledge is irreducibly group knowledge. It is argued that by making clear this three-tiered structure of social scientific knowledge a prima facie challenge is posed for defenders of distributed scientific cognition and knowledge to explain why this form of social knowledge is being exhibited and not one of the two weaker (and metaphysically less demanding) forms of social knowledge.
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Affiliation(s)
- Duncan Pritchard
- Department of Philosophy, University of California, Irvine, Irvine, CA, United States
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Obadan-Udoh EM, Gharpure A, Lee JH, Pang J, Nayudu A. Perspectives of Dental Patients About Safety Incident Reporting: A Qualitative Pilot Study. J Patient Saf 2021; 17:e874-e882. [PMID: 34009866 DOI: 10.1097/pts.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient reporting of safety incidents is one of the hallmarks of an effective patient safety protocol in any health care setting. However, very little is known about safety reporting among dental patients or effective strategies for engaging them in activities that promote safety. The goal of this study was to understand the perceptions of dental patients about the barriers and benefits of reporting safety incidents. We also sought to identify strategies for improving patient reporting of safety incidents in the dental care setting. METHODS We conducted 3 focus group sessions with adult dental patients (n = 16) attending an academic dental center from November 2017 to February 2018. Audio recordings were transcribed and analyzed using a hybrid thematic analysis approach with NVivo software. RESULTS Dental patients mainly attributed safety incidents to provider-related and systemic factors. They were most concerned about the financial implications, inconvenience of multiple visits, and the absence of an apology when an incident occurred. The major recommended strategies for engaging patients in safety-related activities included the following: proactive solicitation of patient feedback, what-to-expect checklists, continuous communication during visits/procedures, after-visit summary reports, clear incident reporting protocols, use of technology, independent third-party safety incident reporting platforms, and a closed feedback loop. CONCLUSIONS This study offers a roadmap for proactively working with dental patients as vigilant partners in promoting quality and safety. If properly engaged, dental patients are prepared to work with dental professionals to identify threats to safety and reduce the occurrence of harm.
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Affiliation(s)
- Enihomo M Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, University of California San Francisco (UCSF) School of Dentistry, San Francisco, California
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Chegini Z, Arab-Zozani M, Shariful Islam SM, Tobiano G, Abbasgholizadeh Rahimi S. Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis. Nurs Forum 2021; 56:938-949. [PMID: 34339525 DOI: 10.1111/nuf.12635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/19/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Georgia Tobiano
- Nursing and Midwifery Education Research Unit, Gold Coast University Hospital, Gold Coast, Australia
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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Morey S, Magnusson C, Steven A. Exploration of student nurses' experiences in practice of patient safety events, reporting and patient involvement. NURSE EDUCATION TODAY 2021; 100:104831. [PMID: 33676347 DOI: 10.1016/j.nedt.2021.104831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND/INTRODUCTION Qualified and student nurses remain at the forefront of dealing with, and reporting, patient safety events or incidents. There has been limited exploration of whether and how the patient's perspective is represented by staff or student nurses using formal reporting systems. OBJECTIVES The overall aim of the study was to explore the student nurses' experiences in practice of patient safety events they were themselves directly or indirectly involved in. This specifically explored the subsequent reporting and inclusion of the patient perspectives that may or may not have taken place. DESIGN A qualitative approach to this research was selected using the principles of thematic analysis to analyse data gathered from focus groups of student nurses across all year groups. SETTING Three universities participated in the study located in the north east, south east and east of England. PARTICIPANTS Student nurses from across the year groups attended focus groups. METHODS Following ethical approval and informed consent, participants took part in focus groups within each university setting. Data were transcribed verbatim and analysed using thematic analysis. RESULTS Three themes were identified: the benefit of reporting and patient involvement, the barriers experienced by the students in reporting and the support needed to ensure they do the right thing in practice. CONCLUSION Learning for students from patient safety incidents is important and seeking patients' views and perceptions adds to the learning experience. There are however challenges for the student in practice in both reporting and patient involvement. Resources are needed that follow and feed into the student learning alongside a workforce that see the benefit of learning from those we care for.
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Affiliation(s)
- Sarah Morey
- Northumbria University, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne NE77TR, United Kingdom.
| | - Carin Magnusson
- University of Surrey, Stag Hill University Campus, Guildford. GU27XH, United Kingdom.
| | - Alison Steven
- Northumbria University, Coach Lane Campus, Coach Lane, Newcastle-Upon-Tyne NE77TR, United Kingdom.
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12
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Groves PS, Bunch JL, Cannava KE, Sabadosa KA, Williams JK. Nurse Sensemaking for Responding to Patient and Family Safety Concerns. Nurs Res 2021; 70:106-113. [PMID: 33630533 DOI: 10.1097/nnr.0000000000000487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns. OBJECTIVES The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families. METHODS A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory. RESULTS We enrolled 25 nurses representing 22 units. Based on these nurses' experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient's or family's safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting. DISCUSSION Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses' routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture.
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Groves PS, Bunch JL, Sabadosa KA, Cannava KE, Williams JK. A grounded theory of creating space for open safety communication between hospitalized patients and nurses. Nurs Outlook 2021; 69:632-640. [PMID: 33579513 DOI: 10.1016/j.outlook.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/30/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is evidence that fear of negative nurse response may prevent hospitalized patients from sharing safety concerns, adversely affecting patient safety. PURPOSE The purpose of the present study was to describe the process by which bedside nurses recognize and respond to safety concerns expressed by patients or their families. METHODS Twenty-five bedside nurses from 30 maternal-child, intensive, medical-surgical, and psychiatric inpatient units within an academic medical center participated in semi-structured interviews. Data were analyzed using grounded theory. FINDINGS Nurses reported creating space for open safety communication to foster trust and maintain patient safety and sense of security. Nurses anticipated safety concerns, invited safety discussion, were accessible, recognized insecurity, reacted in a trustworthy way, shared a plan, and followed up with patient and family. DISCUSSION This process involves multiple interacting components, yet was remarkably consistent across acute care settings, despite differences in nurses, patient populations, and unit cultures.
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Lee NJ, Ahn S, Lee M. Mixed-method investigation of health consumers' perception and experience of participation in patient safety activities. BMJ Open 2020; 10:e035831. [PMID: 32213526 PMCID: PMC7170617 DOI: 10.1136/bmjopen-2019-035831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Nam-Ju Lee
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Shinae Ahn
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Miseon Lee
- College of Nursing, Seoul National University, Seoul, Republic of Korea
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Scott J, Finch T, Bevan M, Maniatopoulos G, Gibbins C, Yates B, Kilimangalam N, Sheerin N, Kanagasundaram NS. Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England. BMJ Open 2019; 9:e032925. [PMID: 31831546 PMCID: PMC6924771 DOI: 10.1136/bmjopen-2019-032925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Around one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care. DESIGN Mixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods. SETTING AND PARTICIPANTS Three secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101). ANALYSIS Qualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ2 and Wilcoxon signed-rank test for differences in current and future normalisation. RESULTS Participants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation, legitimation) or unsuccessful normalisation (initiation, differentiation, skill set workability, systematisation). CONCLUSIONS Clinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Tracy Finch
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Mark Bevan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Chris Gibbins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bryan Yates
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | | | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel Suren Kanagasundaram
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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16
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Scott J, Heavey E, Waring J, De Brún A, Dawson P. Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study. BMC Health Serv Res 2019; 19:613. [PMID: 31470853 PMCID: PMC6716906 DOI: 10.1186/s12913-019-4447-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background The aim was to determine the feasibility of implementing a patient safety survey which measures patients’ experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective. Methods Mixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups. Results Patients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients. Conclusions Patients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions. Electronic supplementary material The online version of this article (10.1186/s12913-019-4447-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| | - Emily Heavey
- Department of Behavioural and Social Sciences, University of Huddersfield, Huddersfield, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Pamela Dawson
- PD Education and Health Consulting Ltd, Newcastle upon Tyne, UK
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17
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Chegini Z, Janati A, Bababie J, Pouraghaei M. The role of patients in the delivery of safe care in hospital: Study protocol. J Adv Nurs 2019; 75:2015-2023. [PMID: 31087572 DOI: 10.1111/jan.14045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/18/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022]
Abstract
AIM This paper outlines the protocol for a study aimed at exploring perspectives about the role of patients' in the delivery of safe care in hospital. DESIGN Qualitative exploratory study. METHODS Research Ethics Committee approval for this study was obtained in October 2018. The study will be conducted between February-April 2019 with data collected through focus group discussions and semi-structured interviews and will involve patients and healthcare professionals from hospitals in Tabriz. A descriptive qualitative approach will be adopted, and the data will be managed and analysed using MAXQDA 10 software. DISCUSSION The role of patients in furthering their own safety whilst in hospital cannot be underestimated and the results from this study can be used to support the development of practical strategies that address the delivery of safe hospital care and which involve patients and their caregivers.
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Affiliation(s)
- Zahra Chegini
- Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Students' Research Committee, School of Management and Medical Informatics, Tabriz University of Medical Science, Tabriz, Iran
| | - Ali Janati
- Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Bababie
- Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahboub Pouraghaei
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Heavey E, Waring J, De Brún A, Dawson P, Scott J. Patients' Conceptualizations of Responsibility for Healthcare: A Typology for Understanding Differing Attributions in the Context of Patient Safety. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:188-203. [PMID: 31113253 DOI: 10.1177/0022146519849027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examines how patients conceptualize "responsibility" for their healthcare and make sense of the complex boundaries between patient and professional roles. Focusing on the specific case of patient safety, narrative methods were used to analyze semistructured interviews with 28 people recently discharged from hospital in England. We present a typology of attribution, which demonstrates that patients' attributions of responsibility to staff and/or to patients are informed by two dimensions of responsibility: basis and contingency. The basis of responsibility is the reason for holding an individual or group responsible. The contingency of responsibility is the extent to which that attribution is contextually situated. The article contributes to knowledge about responsibility in complex organizational environments and offers a set of conceptual tools for exploring patients' understanding of responsibility in such contexts. There are implications for addressing patient engagement in care, within and beyond the field of patient safety.
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Affiliation(s)
| | | | | | - Pamela Dawson
- 4 PD Education and Health Consulting Ltd., Newcastle upon Tyne, UK
| | - Jason Scott
- 5 Northumbria University, Newcastle upon Tyne, UK
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19
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Hernan AL, Kloot K, Giles SJ, Beks H, McNamara K, Binder MJ, Versace V. Investigating the feasibility of a patient feedback tool to improve safety in Australian primary care: a study protocol. BMJ Open 2019; 9:e027327. [PMID: 31061052 PMCID: PMC6501999 DOI: 10.1136/bmjopen-2018-027327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/16/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patients are a valuable source of information about ways to prevent harm in healthcare, and can provide feedback about the factors that contribute to safety incidents. The Primary Care Patient Measure of Safety (PC PMOS) is a novel and validated tool that captures patient feedback on safety and can be used by primary care practice teams to identify and prevent safety incidents. The aim of this study is to assess the feasibility of PC PMOS as a tool for data-driven safety improvement and monitoring in Australian primary care. METHODS AND ANALYSIS Feasibility will be assessed using a mixed-methods approach to understand the enablers, barriers, acceptability, practicability, intervention fidelity and scalability of C PMOS as a tool for safety improvement across six primary care practices in the south-west region of Victoria. Patients over the age of 18 years attending their primary care practice will be invited to complete the PC PMOS when presenting for an appointment. Staff members at each practice will form a safety improvement team. Staff will then use the patient feedback to develop and implement specific safety interventions over a 6-month period. Data collection methods during the intervention period includes audio recordings of staff meetings, overt observations at training and education workshops, reflexive researcher insights, document collection and review. Data collection postintervention includes patient completion of the PC PMOS and semistructured interviews with staff. Triangulation and thematic analysis techniques will be employed to analyse the qualitative and content data. Analysis methods will use current evidence and models of healthcare culture, safety improvement and patient involvement in safety to inform the findings. ETHICS AND DISSEMINATION Ethics approval was granted by Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 175_2017). Study results will be disseminated through local and international conferences and peer-reviewed publications.
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Affiliation(s)
- Andrea L Hernan
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kate Kloot
- Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Sally J Giles
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Hannah Beks
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kevin McNamara
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Marley J Binder
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
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20
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Schildmeijer K, Nilsen P, Ericsson C, Broström A, Skagerström J. Determinants of patient participation for safer care: A qualitative study of physicians' experiences and perceptions. Health Sci Rep 2018; 1:e87. [PMID: 30623042 PMCID: PMC6266354 DOI: 10.1002/hsr2.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/20/2018] [Accepted: 08/01/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE There is a paucity of research on physicians' perspectives on involving patients to achieve safer care. This study aims to explore determinants of patient participation for safer care, according to physicians in Swedish health care. METHODS We used a deductive descriptive design, applying qualitative content analysis based on the Capability-Opportunity-Motivation-Behaviour framework. Semi-structured interviews were conducted with 13 physicians in different types of health care units, to achieve a heterogeneous sample. The main outcome measure was barriers and facilitators to patient participation of potential relevance for patient safety. RESULTS Analysis of the data yielded 14 determinants (ie, subcategories) functioning as barriers and/or facilitators to patient participation of potential relevance for patient safety. These determinants were mapped to five categories: physicians' capability to involve patients in their care; patients' capability to become involved in their care, as perceived by the physicians; physicians' opportunity to achieve patient participation in their care; physicians' motivation to involve patients in their care; and patients' motivation to become involved in their care, as perceived by the physicians. CONCLUSION There are many barriers to patient participation to achieve safer care. There are also facilitators, but these tend to depend on initiatives of individual physicians and patients, because organizational-level support may be lacking. Many of the determinants are interdependent, with physicians' perceived time constraints influencing other barriers.
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Affiliation(s)
| | - Per Nilsen
- Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Carin Ericsson
- Cardiology and Speciality Medicine CentreUniversity Hospital in Linköping, Region ÖstergötlandSweden
| | - Anders Broström
- Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Janna Skagerström
- Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
- Research and Development Unit in Region ÖstergötlandLinköpingSweden
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21
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Phipps DL, Giles S, Lewis PJ, Marsden KS, Salema N, Jeffries M, Avery AJ, Ashcroft DM. Mindful organizing in patients' contributions to primary care medication safety. Health Expect 2018; 21:964-972. [PMID: 29654649 PMCID: PMC6250879 DOI: 10.1111/hex.12689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 12/01/2022] Open
Abstract
Background There is a need to ensure that the risks associated with medication usage in primary health care are controlled. To maintain an understanding of the risks, health‐care organizations may engage in a process known as “mindful organizing.” While this is typically conceived of as involving organizational members, it may in the health‐care context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety. Method Qualitative focus groups and interviews were carried out with 126 members of the public in North West England and the East Midlands. Participants were taking medicines for a long‐term health condition, were taking several medicines, had previously encountered problems with their medication or were caring for another person in any of these categories. Participants described their experiences of dealing with medication‐related concerns. The transcripts were analysed using a thematic method. Results We identified 4 themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with health‐care professionals; and the relationship between patients and the health‐care system (in particular, mutual trust). Conclusions Mindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and are strengthened by) patients’ engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement.
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Affiliation(s)
- Denham L Phipps
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Penny J Lewis
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Kate S Marsden
- Division of Primary Care, School of Medicine, The University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Ndeshi Salema
- Division of Primary Care, School of Medicine, The University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Mark Jeffries
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Anthony J Avery
- Division of Primary Care, School of Medicine, The University of Nottingham, Queens' Medical Centre, Nottingham, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
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22
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Scott J, Birks Y, Aspinal F, Waring J. Integrating safety concepts in health and social care. JOURNAL OF INTEGRATED CARE 2017. [DOI: 10.1108/jica-01-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose
Keeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England.
Design/methodology/approach
This paper presents the authors’ viewpoint based on personal, professional and research experience.
Findings
In healthcare, safety is usually conceptualised as the management of error, with risk considered on a universal level. In social care, the safeguarding process balances choice and control with individualised approaches to keeping adults safe, but lacks the established reporting pathways to capture safety incidents. Efforts to safely integrate health and social care services are currently constrained by a lack of shared understanding of the concepts of safety and safeguarding without further consideration of how these approaches to keeping people safe can be better aligned. As such, there is a need for a single, unified discourse of patient safety that cuts across the patient safety and safeguarding concepts and their associated frameworks in health and social care settings.
Originality/value
A single unified concept of safety in health and social care could coincide with an integrated approach to the delivery of health and social care, improving the care of patients transitioning between services.
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