Putting the patient in patient safety: qualitative exploration and co-design of a new paradigm

Abstract

There has been increasing interest in involving patients in patient safety. Whilst interventions have been introduced to support this, there are still barriers to patient involvement. Currently, there is a focus upon the clinical risk paradigm, where policymakers, academics and healthcare professionals define patient safety; however, evidence suggests that patients and healthcare professionals may conceptualise patient safety differently. This means that patient safety, as it is currently defined, may not be meaningful or accessible to patients. It is therefore necessary to understand, value and incorporate the patient perspective to support genuine patient involvement. This thesis aims to explore and compare different stakeholder perspectives of patient safety using qualitative methods, and reconcile these in a new patient safety paradigm. Chapter 1 provides the background to patient safety and patient involvement, and addresses the rationale for the thesis. Chapter 2 details the qualitative methods to be used in this research. Chapter 3 presents a systematic review using meta-study methodology to synthesise the current qualitative evidence that explores patient and healthcare professional perceptions of patient safety. Chapters 4 and 5 use constructivist grounded theory to explore patient and healthcare professional perceptions of patient safety within acute medicine for the elderly, elective surgery and maternity, and develop explanatory theory for their conceptualisations of patient safety. Additionally, these chapters allow a comparison of healthcare professional and patient conceptualisations, as well as comparison to existing definitions and models for patient safety. Chapter 6 presents the results of a co-design workshop involving patients and healthcare professionals in elective surgery; this utilises the qualitative findings of the thesis to develop a practical product that, if implemented, will broaden the current patient safety paradigm by identifying, understanding and using the patient perspective. Finally, Chapter 7 discusses the implications of this research for patient safety policy and practice.Open Acces