Patient safety: what role can patients play?

The publication in 2000 of two reports drawing attention to the problem of medical errors and adverse events led to an increase in research and reporting systems designed to improve understanding of the nature and causes of patient safety problems and the effectiveness of preventive strategies.1, 2 While progress has been made in a number of areas, the patient's role in protecting and promoting their own safety has been relatively ignored by researchers.3 In a previous study, we argued that patients have a key role to play in helping to reach an accurate diagnosis, in deciding about appropriate treatment, in choosing an experienced and safe provider, in ensuring that treatment is appropriately administered, monitored and adhered to, and in identifying adverse events and taking appropriate action.4 However, we also acknowledged that this is a relatively unexplored area, that many problems – both practical and ethical – will undoubtedly emerge, and there is an urgent need for good quality research. A number of organizations have produced check lists for patients, advising them to play an active role in ensuring their safety.5 Suggested actions include selecting providers carefully, giving health professionals information relevant to your care, encouraging health professionals to adopt safety-promoting practices, checking to ensure treatment is given as planned and care plans are followed through, being informed about your condition and treatment, being actively involved in your care and encouraging the active involvement of family members. However, Entwistle et al. have pointed to the lack of evidence of effectiveness of these strategies, and the possibility that the advice may do more harm than good.5 While the research literature on this topic is sparse, a few studies have produced positive results, suggesting this may be a fruitful area to pursue. For example, patients appear to be quite good at identifying and reporting adverse drug events and at reminding staff to wash their hands.6-8 But there is a great deal more we need to know. For example, to what extent, and in what ways, do patients want to take a role in safety improvement? What are the positive and negative effects of increasing patient and public awareness of safety issues? How effective are current attempts to engage patients in ensuring their safety? Which techniques (e.g. posters, question sheets, staff badges, advice leaflets) are most effective in encouraging and supporting patients to openly raise safety concerns with professionals? What reactions do patients experience when they draw attention to potential safety problems? Health Expectations would like to contribute to the development of understanding on this important topic. We would very much welcome viewpoint articles and research papers that can shed light on any of the questions raised above.