Patient involvement in safety
Project summary
Approximately 10% of hospital inpatients experience adverse events due to their medical treatment. Patients themselves could help to reduce rates of adverse events by actively participating in their healthcare. At most stages of the care pathway there are opportunities for patients to contribute to their healthcare safety, including, for example, accurate provision of diagnostic information, involvement in treatment decisions, choice of healthcare provider, and the management and the monitoring of adverse events.
In recent years a number of healthcare and patient safety organisations and coalitions (in the UK and elsewhere) have introduced a variety of patient-focussed initiatives aimed at facilitating patient involvement in safety by encouraging patients to ‘Speak up’ and ask healthcare staff questions if they have any concerns about their healthcare management. However, whilst such initiatives are well intentioned, there is a paucity of empirical research on their acceptability of these initiatives from the patients’ perspective and the extent to which patients would want to take on such an active role.
Our research on patient participation in patient safety aims to address this gap in the literature through a series of research projects. The overarching aims are (i) to investigate to what extent patients are able and willing to participate in patient safety and (ii) to assess the efficacy of patients’ involvement in safety in reducing medical errors/adverse events.
This project comprises a number of elements, as follows:
- To what extent are patients able and willing to participate in improving the safety of the healthcare? A systematic review. This review aims to systematically synthesise extant data from the patient involvement in safety paradigm in order to understand how willing and able patients are to participate in safety-related behaviours, delineate factors that can effect patient involvement in safety, and highlight strategies to effectively engage patients in the safety of their healthcare
- Patients’ willingness to participate in safety-related behaviours. This project investigates patients’ willingness to participate in a variety of safety-related behaviours recommended by current patient involvement in safety initiatives (e.g. asking healthcare if they have washed their hands, notifying staff if an error occurs in their care, checking they have been given the correct medication). Specific aims of the project are to investigate patients’ baseline willingness to participate in safety-related behaviours, to delineate factors that could influence patient involvement, and to investigate the extent to which healthcare professionals could help to encourage patient participation in safety-related behaviours.
- Patient involvement in safety: the healthcare professionals’ perspective. Given that patient involvement in safety is partly a function of what patients do in relation to their healthcare but also largely to do with their interactions with healthcare professionals it is important that both patients and healthcare professionals hold similar values and beliefs on patient participation in safety. Both need to recognise the benefits of such involvement and healthcare professionals need to encourage such activity from the patient so that the patient feels able and willing to speak up and voice any questions or concerns they may have. Therefore in order for patients to be effectively engaged, the views of healthcare professionals also need to be taken into consideration. This project aims to investigate this from two angles: the extent to which healthcare professionals would be willing to support patient involvement in safety-related behaviours, and the extent to which healthcare professionals, if they were a patient themselves, would be willing to participate in safety-related behaviours
- The role of social cognition models in predicting patient involvement in safety. Social cognitive theory provides a framework for understanding, predicting, and changing human behaviour. The theory identifies human behaviour as an interaction of personal factors, behaviour, and the environment. Centred on this theory a number of social cognition models (e.g. the Health Belief Model and the Theory of Planned Behaviour) have been developed to help explain why individuals may (or not) participate in various health-related behaviours. These models have been used extensively within health research to gain a deeper understanding of patients’ uptake (or lack thereof) of a variety of behaviours (e.g. smoking cessation, screening behaviours, medication compliance, alcohol use). The extent however to which such models can be used to predict patient involvement in safety-related behaviours has received very little attention. This project aims to address this gap in the literature. Specifically we aim to investigate the extent to which social cognition models can be used to predict patient involvement in safety, and to explore whether specific models may be better at predicting patient involvement in some safety-related behaviours but not others.
- Facilitating patient involvement in safety: what are the most effective strategies to encourage involvement? At present it is not clear what the most effective strategy is to communicate with patients to encourage them to participate in their healthcare safety. Are leaflets best? Or would a video be the most appropriate medium? Or perhaps a multi-method approach? The present study aims to compare patients’ views on the use of written leaflets and the P.I.N.K video to explore what strategy patients think is most effective, and whether a single or multi-method approach to engage patients should be used
- Using leaflets to facilitate patient involvement in safety: the patients’ perspective. In recent years a number of patient education leaflets have been designed aimed at encouraging patients to participate in various aspects of their healthcare safety. However, while well intentioned, is it is not clear whether the patients’ perspective was included at the design stage of the leaflets, or whether patients even know about these leaflets, and if so, what their views are. The aims of the present study are to evaluate patients’ views on patient involvement in safety leaflets in terms of: Knowledge – do they know these leaflets exist? Accessibility – if patients have heard of these leaflets do they know where to find/access them? Understanding – are the leaflets easy to understand? Importance – do they think the leaflets are important? If so what do they think the benefits are?
Project team
- Rachel Davis (PI and key contact)
- Nick Sevdalis
Project outputs
Peer-reviewed papers
- Davis, R, Sevdalis, N, Vincent, C. Patient involvement in patient safety- How willing are patients to participate? BMJ Quality and Safety, 2011; 20: 108-114
- Davis, R. Patient Involvement in Safety – the patient as part of the safety solution. How can patients be involved? NHS Evidence – Patient and Public Involvement, 2008
- Davis, R., Koutantji, M, Vincent, C. Patients’ willingness to question health care staff on issues related to their medical treatment, Quality and Safety in Health Care, 2008. 17; 90-96.
- Davis R; Sevdalis N; Vincent C. The role of the HBM and the TPB in predicting patient involvement in safety. Psychology and Health, 2008, 23:99-99.
- Davis, R., Sevdalis, N., & Jacklin, R. Vincent, C. Patient involvement in safety: What factors influence patient participation and engagement? Health Expectations, 2007: 10: 3; 259-267.
- Koutantji, M., Davis, R., Vincent, C., Coulter, A. The Patient’s role in patient safety: engaging patients, their representatives, and health professionals. Clinical Risk, 2005: 11(3); 99-104(6).
Conference presentations
- Davis, R. Patient involvement in patient safety, (oral presentation). National Patient Safety Agency, 2008.
- Davis, R., Koutantji, M., Vincent, C., Patients’ willingness to question healthcare staff about their care (poster presentation). Annual Division of Health Psychology Conference, University of Essex, 2006.
- Davis, R., Koutantji, M., Vincent, C. How willing are patients to ask doctors and nurses questions about the quality and safety of their healthcare? (poster presentation). Patient Safety Research Conference, Porto, 2007.
- Davis, R., Koutantji, M., Vincent, C. Patients’ willingness to ask healthcare staff safety-related questions about their healthcare. (oral presentation). The International Society for Quality in Health Care Conference, Boston, 2007.
- Davis, R, Elkin, M, Sevdalis, N, Vincent, C. Patient involvement in safety- Do patients want to be involved? (oral presentation). Healthcare Ergonomics and Patient Safety, Strasburg, 2008
- Davis R., Sevdalis, N., Vincent, C. Patient involvement in safety-related behaviours. International Society for Quality and Safety in Healthcare. (oral presentation) Copenhagen, 2008.
- Davis, R., Sevdalis, N., Vincent, C The Theory of Planned Behaviour: A useful model for predicting patient involvement in safety. International Society for Quality and Safety in Healthcare. (poster presentation) Copenhagen, 2008.
- Davis, R., Sevdalis, N., Vincent, C. Using Technology to Empower Patients to become more involved in safety-related behaviours: Assessing the P.I.N.K. Patient Safety Video. International Society for Quality and Safety in Healthcare. (poster and short oral presentation) Copenhagen, 2008
- Davis, R., Sevdalis, N., Pinto, A, Vincent, C. Patients' evaluation of a video aimed at encouraging patient participation in healthcare. European Division of Health Psychology Conference (poster presentation) Bath, 2008.
- Davis, R., Sevdalis, N., Vincent, C. The role of the HBM and the TPB in predicting patient involvement in safety. European Division of Health Psychology Conference (poster presentation) Bath, 2008.
- Davis, R., Sevdalis, N., Vincent, C The role of the patient in preventing medical errors in health care. Health Protection Agency (poster presentation) Warwick, 2008
- Davis, R., Pinto, A, Sevdalis, N, Vincent, C, Darzi A. A useful tool for encouraging patient participation in safety, BMJ International Forum for Quality and safety in Healthcare, Berlin, (poster presentation) 2009
- Pinto, A., Davis, R., Sevdalis, N., and Vincent, C. Evaluation of a patient education video aimed at empowering patients to be involved in their healthcare, ISQua Conference (oral presentation) Dublin, 2009.
- Davis, R., Sevdalis, N, Vincent, C. The role of health behaviour models in predicting patient involvement in safety, 2nd North British Patient Safety Symposium, Aberdeen, (oral presentation), 2009
- Davis, R., Sevdalis, N, Vincent, C. The use of video & leaflet in encouraging patient involvement in safety, 2nd North British Patient Safety Symposium, Aberdeen, (oral presentation), 2009
- Davis, R, Sevdalis, N, Vincent, C. How willing are patients to participate in safety related behaviours? 24th European Health Psychology Conference in Cluj-Napoca, (poster presentation), 2010
- Davis, R, Brodie, A, Sevdalis, N, Vincent, C. How able and willing are patients to participate in the safety of their healthcare? A systematic review. 27th International Conference of the International Society for Quality in Health Care, Paris, (poster and short oral presentation), 2010.
- Davis, R, Sevdalis, N, Neale, N, Massey, R, Vincent, C. What can patients tell us about medical errors in their care? 27th International Conference of the International Society for Quality in Health Care, Paris, (post and short oral presentation), 2010
- Davis, R, Sevdalis, N, Vincent, C. The use of social cognition models in predicting patients' intentions to participate in safety-related behaviours. 27th International Conference of the International Society for Quality in Health Care, Paris, (oral presentation), 2010
- Davis, R, Sevdalis, N, Vincent, C. The role of social cognition models in predicting patient involvement in safety, 24th European Health Psychology Conference, Romania, (poster presentation), 2010
- Davis, R, Sevdalis, N, Vincent, C. The use of video and leaflet in encouraging patient involvement in safety, 24th European Health Psychology Conference, Romania, (oral presentation), 2010
- Davis, R, Sevdalis, N, Vincent, C. The use of the Theory of Planned Behaviour and Health Belief Model in predicting patient involvement in safety BPS DHP Annual Conference, Belfast (poster presentation), 2010
- Davis, R, Sevdalis, N, Vincent, C Interventions to encourage patient involvement in safety. BPS DHP Annual Conference, Belfast (oral presentation), 2010.
Awards and Acknowledgments
- QSHC article recommended to read by Bernie Harrison for the Faculty of 1000 (post-publication peer reviewed publications) - Davis, R., Koutantji, M, Vincent, C. Patients’ willingness to question health care staff on issues related to their medical treatment, Quality and Safety in Health Care, 2008. 17; 90-96
- Runners up for the Department of Health, Health and Social Care Awards, London Regional Awards, 2008 - Massey, R, Davis, R, Vincent, C, Davies R, Warren, O, Darzi A. The PINK Patient Safety Video Health and Social Care Awards, Davis, R., Sevdalis, N., & Jacklin, R. Vincent, C.
- Health Expectations article voted by BioMedLib one of the top 10 articles in its domain since publication - Patient involvement in safety: What factors influence patient participation and engagement? Health Expectations, 2007: 10: 3; 259-267).
Project funder
Project start and end dates
September 2006 - September 2009
