How vulnerability affects the co-creation of patient safety: Views of acute medical patients
Patient safety is defined as the prevention, avoidance and amelioration of harms stemming from medical mismanagement and is traditionally viewed through a clinical lens. Drawing on twenty-eight interviews with acute medical patients my research explored how patients understood safety and how those understandings helped to shape their involvement in safety while they were in hospital.
Patients’ perspectives and experiences of being safe or unsafe were generated through their interactions with both staff and the environment around them. Patients understood safety as being cared for and about. In order to feel safe, patients needed reassurance that they were cared for, and that staff were acting in their best interests and following the right procedures. Being cared for helped to minimise the risks associated with their illness, their environment and from the people they were dependent on. Overall, patients felt unsafe when they felt vulnerable to the possibility of harm. Patients’ understandings of safety therefore arose from their vulnerability to their illness, the uncertainties they experienced and their dependence on others while hospitalised.
Patients were aware of their own vulnerability and their dependence. They participated in their safety by adopting strategies that displayed their vulnerability and sought to minimise these risks of harm. These strategies included being a ‘good patient’ and being compliant. Compliance, usually regarded as passive was an active strategy that patients used to generate good relations. By doing as they were told, patients were able to invite good care which, in turn, helped to build relationships between patient and professional. Patients also attempted to have some control over and management of their care.
Patients also minimised risks to their safety by being vigilant and raising concerns when something felt wrong. Patients raised queries when they needed clarity and when they felt vulnerable. For example, when they were concerned about not receiving a medication that took regularly, when they felt degraded or concerned about an aspect of their care, or when frightened that they were going to die. Patients therefore spoke up when they perceived a risk to themselves or to others and because of the precarity of their situation took action to minimise their chances of being harmed. It is important to note that patients attempted to diminish risks from mistakes and also from damaging practitioner/patient relationships.
1. A ward promise
Healthcare organisations should recognise the extent to which hospitals may be frightening for newly admitted inpatients. To overcome this, organisations and patient representatives should work together to produce a patient and ward promise. This promise should include the ways that staff will promise to act when the patient is admitted and outline the steps staff agree to take if patients have concerns. This should be provided to all patients when they are admitted.
2. Create opportunities for active listening
Healthcare organisations and particularly patient safety leaders should explore ways of specifically creating time for staff to actively listen to patients and their concerns on a daily basis. This time could be part of an existing patient safety ‘huddle’ or during ward rounds, but the point should be to create opportunities for listening to patients’ concerns. This activity should be focused on reaching out to the patient through active listening. Patient safety leaders should also explore ways for healthcare professionals to build time for reflection and learning from their everyday practices.
3. Provide relational training
Training for staff should encompass the nature of what it means to be a patient, often elderly and frightened, in acute care. This could include training packages for staff containing videos that illustrate examples of patient vulnerability. This staff-facing training would focus on developing healthcare professionals’ relational skills, particularly the ability to watch out for signs that patients may have unexpressed concerns or worries. It would also demonstrate to staff how patients attempt to co-create safety and in so doing provide staff with support in accomplishing co-produced safety in the acute care context.
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