WBB's Thought Leadership

Study of Patient Involvement to Improve Patient Safety

February 14

Trial demonstrated patient reporting and feedback has potential to be effective in reducing patient harm.

Study was conducted in 33 hospital wards across five hospitals in the U.K.

Excerpt: “Rates of adverse events during hospitalisation have been estimated at between 3% and 16% globally and, despite increasing attention, have demonstrated very little improvement over the last 10 years. 

“The role that patients could play in promoting safety and reducing adverse events is now an international policy priority. For example, the WHO's World Alliance for Patient Safety cites mobilisation and empowerment of patients as one of six action areas that will be taken forward in its ‘Patients for Patient Safety’ programme.2 Despite international emphasis and repeated calls for greater patient involvement,3 Wachter referred to the lack of progress in this area as a ‘troubling gap’, when rating the achievements of healthcare in promoting safety.4

“Perhaps even more troubling is the dearth of research evidence on how best to involve patients and whether such involvement leads to improvements in safety. The evidence that does exist indicates that patients are willing and able to participate in error prevention strategies5 that have the potential to improve safety.6–9  However, there can be a reluctance to challenge staff and provide negative feedback that might directly impact on the quality of their care,1011   and there is a risk of shifting responsibility for safety onto patients.12

“This study was conducted in 33 hospital wards, across five hospitals (three National Health Service (NHS) Trusts) in the UK. At the small district hospital, all adult non-intensive wards were recruited (N=9). At the medium-sized teaching hospital Trust, the chief nurse recruited 10 adult wards to the study. Within the large Trust, wards (N=14) were asked to volunteer to take part.

“An average of 25 patients meeting the following eligibility criteria within each ward were recruited at three different time points: ≥aged 16, able to give informed consent and minimum period of 4 hours on the ward before questionnaire administered. Patients were excluded if they were too ill or distressed to take part and had already been in the study within the previous month or were non-English or non-Mirpuri-speaking patients.”

“…[T]he trial demonstrates that patient reporting and feedback is feasible and acceptable to patients and that, where compliance with the intervention is high, there is potential for it to be effective in reducing patient harm.”

Source: BMJ

WBB Take: The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. A central focus of Lean Six Sigma is the need for all quality efforts to be aligned to the Voice of the Customerr (VoC). In healthcare, this means the patient’s voice, yet few quality measure in the National Quality Measures Clearinghouse (NQMC) are proxies for patient outcome, and fewer still are obtained from patient input. The lack of patient involvement in developing measures, collecting quality data, and understanding cost of noncompliance has led to missed opportunities and increased risk and waste. Lawton et al describe the use of the Patient Reporting and Action for a Safe Environment (PRASE) intervention at 33 hospital wards. The intervention demonstrated a repeatable modality for patient involvement and participation in healthcare improvement. WBB strongly supports this, and echoes the need for patient involvement and maintaining VoC in the design and execution of healthcare improvement initiatives.


Cited by Matthew Loxton

Cited by Matthew Loxton

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