General practice staff and patient perceptions of patient involvement in improving safety in primary care

Problem

Improving the safety of healthcare is an international priority, and there is a growing awareness of value in partnering with patients and families to achieve this aim. Little is understood about the role that patients and families could play in improving safety in primary care, how this might be best supported, or how patients, relatives and healthcare staff feel about encouraging such involvement. This study explores these issues from the perspective of both general practice staff and service-users with a view to further involving them in the co-design of an intervention that will support collaborative safety vigilance in primary care.

Approach

This is a mixed methods study using qualitative inquiry, thematic analysis and co-design workshops. Twenty staff (GPs, nurses, health care assistants and administrative staff) from five general practices in North East England took part in semi-structured interviews. Interviews with up to 20 patients/relatives are on-going (7 completed to date). These findings, a literature review, and a scoping review of existing interventions, will inform three co-design workshops. Service-users and staff will work together to co-develop resources to support collaborative involvement of patients and families in improving patient safety. Preliminary findings from staff and patient interviews are reported here.

Findings

The findings offer insight into staff, patient and family understandings of patient safety within general practice that encompass a number of areas where harm due to error can occur (e.g. diagnosis, prescribing, cross-infection, non-compliance). Accounts also demonstrate a shared knowledge of potential patient harm in relation to adverse effects of medications or treatment. Collaborative systems exist to help avoid patient harm in the latter situation, where patients and relatives are informed by staff about what to look out for and when to seek advice, working together to keep the patient safe. However, such direct communication of safety concerns identified by patients or relatives in the context of error is not so straight forward. Staff were sceptical regarding patient willingness to adopt this role, citing patient preferences and capacity to be involved, and concerns relating to relationships with staff and subsequent care. Patient accounts share some of these features but also include practical barriers, such as ‘getting past the receptionist’.

Consequences

Though preliminary, our findings suggest that within a ‘permissive’ context patients, relatives and healthcare staff can and do work together collaboratively to keep patients safe. This appears to be a more acceptable process in contexts where the source of potential harm has not arisen from the care provider. Further analysis will consider how this level of acceptability can be achieved to support similar collaborative interactions in the midst of potential iatrogenic harm, drawing on models of behaviour change, and current approaches to supporting collaborative improvement of patient safety (e.g. ThinkSAFE www.thinksafe.care)