Co-designing a Primary Care Patient Safety Handbook: using an experience based co-design approach and embedded qualitative study
A key challenge of primary care patient safety is how to keep patients safe in the potentially hazardous environment of healthcare. Interventions to improve primary care patient safety need to move beyond involving patients in the identification of errors to actively involving them in preventing and reducing them. An experience based co-design (EBCD) approach has been used to develop, implement and evaluate participatory approaches in quality improvement initiatives. Whilst the EBCD approaches may be tailored, the underlying principle is to work in collaboration with those who will be the end-users of the intended initiatives, in this case patients, families, carers and health care staff within primary care. This project aimed to use an EBCD approach to develop a patient safety handbook and identify processes that may enable or constrain its implementation into routine care delivery.
The EBCD approach was used to develop a prototype of the patient safety handbook resource (including paper and online versions). An initial scoping exercise of primary care patient safety issues was conducted. A co-design event was conducted with General Practitioners, pharmacists, patients and carers (n=30). Semi-structured interviews with 20 patients and carers were conducted to examine in-depth existing strategies used to ensure safety and to examine the work required to implement the patient safety handbook for patients and carers. The Normalisation Process Theory was used as a framework for generation and analysis of the data and informed the final refinement of the handbook.
The EBCD approach was used to develop a primary care patient safety handbook to identified key patient safety questions that need to be addressed. Participants identified the main factors that impacted on their engagement with patient safety and actions that could be implemented to improve patient safety along the primary care interface. The qualitative study identified the work involved to use a patient safety handbook by patients and carers that would influence its implementation with routine care. Factors affecting uptake and use of the handbook related to collective engagement within and across services as well as uncertainties around how to embed it in clinical encounters. The use of cue cards during consultations, and a longer handbook for reference before and after consultations, was preferred.
Using an EBCD approach and in-depth qualitative study identified important points where patient safety in routine primary care can be improved using patient and clinician experiences. The implementation of the handbook resource requires education and awareness campaigns to support local implementation within a whole systems approach. Involving patients and clinicians in the development of the handbook improved the final handbook design. This has implications for the development and implementation of primary care patient safety initiatives and their future sustainability.