Perception And Theoretical Framework Of Patient Participation In Patient Safety: A Grounded Theory Study Of Patient Experience

BackgroundInternationally, it has been increasingly recognized that providing effective and safe care is the ultimate goal in health care. However, great challenges have been faced in improving patient safety globally. Ever since the Institute of Medicine published its report'To Err Is Human'in 1999, concerns about medical errors and patient safety have multiplied. The WHO World Alliance for Patient Safety has launched a series of initiatives in recent years to improve both research and practice of patient safety across the world, which include a number of initiatives encouraging patient involvement in safety. For instance,'Patients For Patient Safety'has been one of the main action areas to engage patients in safety management. However, research into the role of patients and strategies for enhancing patient involvement in safety has been limited.ObjectiveThis project aims to find out what roles patients play in the safety of hospital care and their knowledge and attitudes towards safety of hospital care. Focusing on the theme of patient involvements and patient-providers communication, the main research questions include: (1) What is the perception and knowledge of patients about the safety of hospital care? (2) How do patients make decisions on the safety of their hospital care? (3)What is the best way to inform patients to engage in safety of hospital care?MethodsA qualitative research approach was adopted. A purposive sampling strategy incorporated with theoretical sampling and snowballing strategies was used to recruit participants from 2 primary, 2 secondary and 2 tertiary hospitals in Shanghai. The sample of participants was selected to vary by gender, age, adverse events experience and social demographic characteristics to ensure the data contained a diverse sample. Media reports about patient safety and medical disputes were selected for supplementary data analysis. A total of 34 patients who have been recently discharged from hospitals were interviewed. They were asked to tell their experiences in hospitals, including their perceptions of safety and how they act to ensure their safety. All the interviews were recorded on digital recorders, and then transcribed into word documents. Nvivo 7.0 was used to help the data analysis. Important themes of experience of patients were extracted through substantive and theoretical coding strategy guided by the grounded theory.ResultsTwo themes were drawn from this qualitative study. Firstly, patients saw their safety in medical care as a vital element in safety, which include the concepts, contents and strategies of patient safety risk deduction. Secondly, a theme of interactive involvement in patient safety was drawn, including 8 categories, which eventually contributed to the development of a theoretical framework of patient involvement in patient safety. Three strategies of patient involvement in patient safety such as decisive involvement, caring involvement and complaining involvement in patient safety were concluded. Four elements including patient-provider trust, medical information support, imprompt communication between patient and professionals, and support both from family and professionals play important roles in helping patients engage in safety of hospital care. Benefit for patient safety is the ultimate outcome for patient involvement in safety. Seven hypotheses were drawn.ConclusionsA theoretical framework for enhancing patient involvement in patient safety was developed, which would guide the development of strategies for"Patient for Patient Safety".