How do patients and carers want to be involved in primary care patient safety? A qualitative study examining the role of a patient safety guide in primary care

Problem

Increasingly support is given to person-centred approaches in health and social care which empower patients and carers to be involved actively in their patient safety. This involves not only asking patients to identify safety concerns and errors, but also to partner in preventing them. Co-design approaches have been used to develop, implement and evaluate participatory approaches in quality improvement initiatives in a variety of settings by working in collaboration with the end-users of the intended initiatives. This project used a co-production approach to develop a primary care patient safety guide and aimed to identify processes that may enable or constrain its implementation into routine primary care, especially general practice and pharmacies.

Approach

A co-design approach was used to develop a prototype of the patient safety guide (including paper and online versions). After an initial brief scoping exercise of patient safety issues was conducted, 2 co-design events with 30 participants per event were took place with a mix of GPs, pharmacists, patients and carers. During the events participants mapped the phases of care in relation to patient safety in priority areas, planned ways of improving patient safety at key points of care, and then worked together to refine the guide. Following the co-design events, semi-structured interviews with 19 patients and carers were conducted to examine patients and carers existing strategies for patient safety and to evaluate the patient safety guide for patients and carers.

Findings

Healthcare professionals, patients, carers, and researchers working together to co-design the patient safety guide enabled the identification of shared priority areas and patient safety questions to address, such as developing a shared understanding of patient safety, understanding each other’s role in safety, and to support collaborative improvement. Factors affecting whether participants would make use of the guide related to engagement within and across services as well as uncertainties around how to embed it in clinical encounters such as consultations. The qualitative study identified a range of patient or carer factors that could influence their engagement in patient safety; such as frequency of contact with services, acute compared to long-term condition management, everyday priorities, carer roles, and relationships with healthcare professionals.

Consequences

Using a co-production approach and in-depth qualitative study identified important areas where patient safety in routine primary care can be improved using patient and clinician experiences. This study provides a more nuanced understanding of how patients and carers want to be involved in patient safety reflected in a continuum of expectations of care and everyday priorities. The guide has the potential to support patients and carers to optimise their use of services and be active in their patient safety.