Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

Abstract

ObjectiveStudies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.MethodMeta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.ResultsForty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.ConclusionOverall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.

Comunicação e cultura de segurança do paciente no ambiente hospitalar: visão da equipe multiprofissional

“…Portanto, para que haja desenvolvimento da assistência de forma eficaz e segura, a comunicação merece ser precisa tanto entre membros da equipe setorial quanto intersetorial, sendo o alicerce das relações, bem como um elemento essencial à prática do cuidado humanizado, integral e reduzido de danos ao paciente. 8,18 Não menos importante, os resultados descritos no item G11 (Tabela 4), em relação à passagem de plantão, dispõe que 46,3% dos profissionais discordam que as mesmas são problemáticas para o paciente no referido hospital, se contradizem com relação à G5, onde 52,9% dos trabalhadores afirmam que informações importantes sobre o cuidado ao paciente se perdem com frequência durante as passagens de plantão.…”

“…7 Na área da saúde, que se constitui num peculiar setor de prestação de serviços, a comunicação tem potencial para subsidiar o cuidado integral e humanizado, e por isso, infere-se que este é um fator que merece atenção à promoção do atendimento seguro em todos os níveis de atenção. 8 Isso porque, falhas nas linhas de comunicação podem favorecer a ocorrência de eventos adversos, 5 que são definidos como incidentes produzidos pelo processo de cuidado que resultam em dano real, de magnitude variada, à saúde do usuário. 2 Especialmente no contexto hospitalar, em que o risco associado à assistência é mais evidente, as linhas de comunicação entre profissionais e/ou setores podem ser um elemento de dificuldade à sua eficácia.…”

Ivan Illich’sMedical Nemesisand the ‘age of the show’: On the Expropriation of Death

“…‘Blame the Patient, Blame the Doctor or Blame the System? A Meta‐Synthesis of Qualitative Studies of Patient Safety in Primary Care’, PLoS ONE , 10.8 (): e0128329. Web.…”

Improving patient safety: should we focus on implementing safety measures rather than searching for more evidence?

“…Some simple interventions, such as introduction of mandatory safe surgery checklists to prevent adverse surgical events (2,3), optimizing antimicrobial use and implementing appropriate hand-hygiene practices to prevent hospital acquired infections (4) have been shown to be useful, but the compliance is not always optimal and difficult to sustain (5), whereas the usefulness of some other resource-consuming procedures, such as adverse event or incident reporting and disclosure systems, remains uncertain (6). Some simple interventions, such as introduction of mandatory safe surgery checklists to prevent adverse surgical events (2,3), optimizing antimicrobial use and implementing appropriate hand-hygiene practices to prevent hospital acquired infections (4) have been shown to be useful, but the compliance is not always optimal and difficult to sustain (5), whereas the usefulness of some other resource-consuming procedures, such as adverse event or incident reporting and disclosure systems, remains uncertain (6).…”

“…There are a number of institutions and advocacy groups that evaluate evidence and/or provide guidance on patient safety issues. Some simple interventions, such as introduction of mandatory safe surgery checklists to prevent adverse surgical events (2,3), optimizing antimicrobial use and implementing appropriate hand-hygiene practices to prevent hospital acquired infections (4) have been shown to be useful, but the compliance is not always optimal and difficult to sustain (5), whereas the usefulness of some other resource-consuming procedures, such as adverse event or incident reporting and disclosure systems, remains uncertain (6). A recent systematic review found that although incident reporting systems may enable organizational learning, they did not perform better than other methods and had little effect on improving patient outcomes (7).…”