Why involve patients in their care

Hospitalized patients are routinely surveyed about their satisfaction with the care they received, and recent research has examined whether patient surveys may be used as an error detection mechanism. Studies in the inpatient setting have found that patients often report errors that were not detected through traditional mechanisms such as chart review; indeed, patient-reported errors formed the basis of landmark studies of adverse events after hospital discharge.

Concerns have been raised, however, that patient complaints may center on poor service quality rather than on clinical adverse events. Self-reported adverse events in health care that cause harm: a population-based survey. Med J Aust. Patients are also being encouraged to take an active role in their own safety. The Agency for Healthcare Research and Quality's Questions Are the Answer program and 20 Tips to Help Prevent Medical Errors fact sheet, as well as The Joint Commission's Speak Up initiative, are examples of programs that educate patients about safety hazards and provide specific questions that patients and their caregivers can ask regarding safety.

Although patients have voiced concerns about engaging in behaviors that may seem confrontational for example, asking their clinician if she washed her hands , some preliminary studies have found that active engagement of patients can improve adherence to safety practices.

The widespread availability of electronic medical records is also being used as an opportunity to engage patients in safety efforts. Early studies have leveraged information technology to incorporate patients in medication reconciliation and early identification of outpatient adverse drug events. Finally, hospitals are increasingly recognizing the crucial role of patients' perspectives in establishing a culture of safety. Many institutions such as the Dana-Farber Cancer Institute have prioritized engaging patient representatives in the design and nurturing of safety efforts, and emphasize transparency in reporting errors and care problems.

The active engagement of patients in safety efforts has extended to allowing patients and families to summon rapid response teams , rather than waiting for clinicians to respond. Studies in the intensive care unit and inpatient pediatric wards have shown that interventions that explicitly include patient and family engagement can improve safety culture and may reduce adverse event rates.

Although patient engagement is a promising strategy for error reduction, there is reason for caution on several grounds. From a systems engineering viewpoint, the level of patient and family participation will always be difficult to predict, leading some to argue that a robust safety program should not depend on such engagement.

Furthermore, patients and caregivers already shoulder a significant emotional burden for ensuring safety while hospitalized. An important study found that a surprising number of patients and family members feel guilty after a medical error, and another study found that most parents of hospitalized children felt personally responsible for ensuring their child's safety in the hospital.

Engaging patients in error prevention therefore risks simply shifting the responsibility for safety from providers and institutions to patients themselves. Patients themselves may be a cause of errors as well as a solution, and some early studies have sought to analyze and classify patient errors. These errors arise from the same underlying causes that contribute to clinicians' errors—while patients may engage in intentionally unsafe behavior, more commonly, patient errors are attributable to the difficulties inherent in an individual's interaction with a complex system.

One study classified patient errors into action errors , which are errors of patient behavior such as failure to attend a scheduled appointment, and mental errors , which include thought process errors such as failing to take a medication as prescribed. Both of these types of error are influenced by other definable safety hazards; for example, low health literacy and poor provider—patient communication are clearly linked to medication errors.

Therefore, a useful construct may be to view patient error as an undesirable outcome that clinicians should actively seek to prevent, using tools that target known risk factors for such errors. For example, lack of knowledge or fear of asking questions may cause patients to take medications incorrectly, but interventions such as pictogram-based medication labels can decrease dosing errors and improve medication adherence.

Patient engagement in safety efforts is a strong priority of influential regulatory and governmental organizations. The Agency for Healthcare Research and Quality and the World Health Organization sponsor a variety of programs centered around patient education and encouraging patient perspectives to improve safety culture. Current Article Getting patients involved in their care is hard.

These 3 strategies can help. Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory. March 1, Getting patients involved in their care is hard.

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We thank the Canadian Foundation for Healthcare Improvement for the funding for this study. Jean-Louis Denis holds a Canada Research Chair on governance and transformation of health systems and organizations. We thank Drs. None of these funding agencies played any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

The Canadian Foundation for Healthcare Improvement provided funding for this study but were not involved in the conception or conduct of the systematic review. The dataset s supporting the conclusions of this article is are included within the article and its additional file s.

Yvonne Bombard, G. You can also search for this author in PubMed Google Scholar. YB and GRB conceived of the study and participated in its design and coordination. KO and PB retrieved the records. EO and CF extracted the data from the eligible articles. YB and GRB developed the initial interpretations of the data and participated in the data analysis.

SC conducted the quality appraisal. YB drafted the manuscript. YB and GRB revised the manuscript. J-LD and M-PP were involved in the study design and oversight; they reviewed the initial data analyses and suggested revisions to the versions of the manuscript.

All authors read and approved the final manuscript. Correspondence to Yvonne Bombard. The author s declare that they have no competing interests. All authors have completed the Unified Competing Interest form at available on request from the corresponding author and declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Table S1. Analysis of patient engagement strategies to improve quality of care. Identification of facilitators and barriers to patient engagement and subsequent evaluation of patient experiences. DOCX kb.