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 semi-structured 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 responsi… Show more
“…However, staff within this study did not appear to engage in quality improvement activities based on patient experiences of safety, and we are therefore only able to conclude that patient feedback on their safety could lead to quality improvement, but that other individual, structural, procedural and cultural conditions are required to be met first. This supports existing research that patients should be involved in the improvement process, providing their involvement is managed correctly [41, 42] and they welcome having some responsibility for their safety [43]. For instance in one study [44] using a national patient survey for quality improvement, it was identified that staff were largely receptive to the survey results but that there were a number of barriers.…”
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 articl...
“…However, staff within this study did not appear to engage in quality improvement activities based on patient experiences of safety, and we are therefore only able to conclude that patient feedback on their safety could lead to quality improvement, but that other individual, structural, procedural and cultural conditions are required to be met first. This supports existing research that patients should be involved in the improvement process, providing their involvement is managed correctly [41, 42] and they welcome having some responsibility for their safety [43]. For instance in one study [44] using a national patient survey for quality improvement, it was identified that staff were largely receptive to the survey results but that there were a number of barriers.…”
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 articl...
“…Discharge was seen by many in the hospital as the end point of responsibility, whilst in the community the diffuse nature of care provision meant that no one took responsibility (Heavey et al . ).I think there just somehow seems to be a void between hospital and community where things sort of fall down. Almost like a bit of a hurdle.…”
Section: Resultsmentioning
confidence: 97%
“…The dilemmas of ‘knowing’ the person and determining ‘eligibility’ set the parameters for establishing professional ‘non‐responsibility’ for care; that is, the inability to define an eligible subject makes the responsibility for care diffuse (Heavey et al . ). This is similar to the ‘problem of many hands’ where the distribution of responsibility amongst multiple actors can mean that no one professional ultimately takes responsibility (Dixon‐Woods and Pronovost ).…”
This paper draws on the work of Giorgio Agamben to understand how the social organisation of care transitions can reduce people to their ‘bare’ life thereby making harmful and degrading treatment seemingly legitimate. The findings of a 2‐year ethnographic study show how some people experience hospital discharge as undignified, inhumane and unsafe process, expressed through their lack of involvement in care planning, delayed discharge from hospital and poorly coordinated care. Our analysis explores how these experiences stem from the way patients are constituted as ‘unknown’ and ‘ineligible’ subjects and, in turn, how professionals become ‘not responsible’ for their care. The result being that the person is reduced to their ‘bare’ life with limited value within the care system. We suggest that the social production of ‘bare life’ is an inadvertent consequence of reconciling and aligning multiple disciplines within a complex care system.
“…As for study design, it was observed that most of the articles (37.9%) used mixed methods 15,16,17,18,19,20,21,22,23,24,25 and the same proportion (31%) adopted qualitative 26,27,28,29,30,31,32,33,34 and quantitative approaches 19,35,36,37,38,39,40,41 . There was variation in sample size and type according to quantitative and/or qualitative design.…”
O objetivo foi revisar a literatura sobre os incidentes, eventos adversos e seus fatores contribuintes no cuidado hospitalar, descritos segundo a perspectiva do paciente. Foi realizada revisão em artigos publicados nas bases MEDLINE, Scopus e LILACS entre os anos de 2008 e 2019. Dentre 2.686 estudos inicialmente levantados, 167 foram pré-selecionados para leitura, 24 selecionados e categorizados de acordo com a análise temática de conteúdo. Na síntese das informações extraídas dos 24 artigos emergiram quatro categorias: terminologia usada para definir incidentes e eventos adversos, destacando-se diferentes nomenclaturas como erro e erro médico; incidentes e eventos adversos identificados pelos pacientes, familiares e cuidadores relacionados ao processo de medicação, cirurgia, infecções relacionadas à assistência à saúde, quedas e lesão por pressão; percepção do paciente quanto os fatores contribuintes para o cuidado inseguro, destacando-se problemas relacionados à comunicação, higienização das mãos e identificação do paciente; sugestões dos pacientes para prevenir a ocorrência de incidentes e eventos adversos, incluindo treinamento de profissionais, elaboração de listas de verificação, escuta do paciente e adequação do ambiente. Pacientes foram capazes de identificar incidentes, eventos adversos e fatores contribuintes na prática do cuidado, que aliados às informações oriundas dos profissionais de saúde podem potencialmente contribuir para a prestação do cuidado em saúde mais seguro.
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