WBB's Thought Leadership

Involving Patients in Quality Improvement

April 2

Study undertaken in 33 wards across three English NHS Trusts between May 2013 and September 2014 suggests that patients can provide insight into quality and safety, and found that 10% of patients identified a patient safety incident. Medication error was the most frequently reported incident category.

WBB Take:  Patients are nominally the primary intended beneficiary of healthcare quality and safety, yet have been historically underrepresented when it comes to quality improvement (QI). Of all the stakeholders consulted when quality, safety, or operational metrics, policies, or priorities are developed or implemented, patients are often the last group to be considered for input and participation. Many operational metrics, medical priorities, and QI interventions are carried out with little or no involvement of patients. As a result, policies, processes, and priorities are often optimized for healthcare professionals, but are suboptimal or even deleterious from the point of view of the patient.
This study looks more closely at the potential for patient participation, and highlights that 10% of the patients involved in the study volunteered examples of safety or quality issues. Making use of patients to identify safety and quality risks, issues, and missed opportunities can help to make healthcare more STEEEPA – safe, timely, effective, efficient, equitable, patient-centered, and affordable. Given the numbers of patients flowing through medical facilities and making use of healthcare services, a 10% rate of observations would yield very high numbers of relevant opportunities for improvement, and do so in a highly patient-centered manner.

Cited by Matthew Loxton

Excerpt: “Patient safety measurement remains a global challenge. Patients are an important but neglected source of learning; however, little is known about what patients can add to our understanding of safety. We sought to understand the incidence and nature of patient-reported safety concerns in hospital.”
“Feedback about the experience of safety within hospital was gathered from 2471 inpatients as part of a multicentre, waitlist cluster randomised controlled trial of an intervention, undertaken within 33 wards across three English NHS Trusts, between May 2013 and September 2014. Patient volunteers, supported by researchers, developed a classification framework of patient-reported safety concerns from a random sample of 231 reports. All reports were then classified using the patient-developed categories. Following this, all patient-reported safety concerns underwent a two-stage clinical review process for identification of patient safety incidents.”

“Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.”
“Our findings suggest that patients can provide insight about safety that complements existing patient safety measurement, with a frequency of reported patient safety incidents that is similar to those obtained via case note review. However, patients provide a unique perspective about hospital safety which differs from and adds to current definitions of patient safety incidents.”

Source: BMJ Quality & Safety


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