Should patient safety be more patient centred

Abstract In a patient-centred health system the views, experiences and rights of the patient drive the way that care is delivered. There is now an increasing emphasis on patient-centredness as an essential characteristic of safe and high quality care, but to date the involvement of patients in patient safety activities has been limited. The views and priorities of patients are not always valued in safety and quality work, and their perspectives are rarely included in activities such as incident investigation. We propose six areas of action to make patient safety more patient centred and hypothesise that the replacement of industrial safety models with a patient-centred model of safety culture will improve clinicians' ability to engage with safety initiatives. Aust Health Rev 2009: 33(3): 390-399 OVER THE PAST DECADE the demand for more patient-centred care has grown in unison with, and as a response to, demands for safer care.* Major patient safety inquiries have repeatedly shown the link between the marginalisation of patients, their families and carers and poorer quality care.1 The importance of involving patients in every aspect of their care is now well recognised.2-4 The Australian National Health and Hospitals Reform Commission, for example, lists "people and family centred care" as the first of eight proposed design principles to guide future directions of the Australian health system.4 The recent review of the National Health Service in the United Kingdom includes empowering patients as one of four actions that are needed to achieve quality.3 While recognition of the importance of patient-centred care as a core component of quality is an important first step, many theoretical and practical questions remain. Patient safety as a field of research and practice has drawn strongly and appropriately from the study of high risk industries. Studies of risk and safety in these industries focus largely on two dimensions: the human factors associated with operators and the processes themselves. In most of these industries, the pivotal relationships are between colleagues (or contractors) and machines. The pivotal role and relationship upon which health care is premised simply does not exist. Even in aviation and rail, where large numbers of clients are directly and adversely affected by errors, the clients themselves are completely removed from the process (unless, on rare occasions, it is clients who raise the alarm). A focus on the mechanics and human factors affecting safety is imperative. This focus however, has resulted in a safety system where not one of the main measures of patient safety - incident reporting, chart review and the use of indicators derived from administrative data (coded from medical records) - incorporates the patient perspective. Solutions to patient safety problems similarly overlook patient experience or patient priorities. In this paper, the problem of the lack of patient-centredness in the current patient safety paradigm is discussed and some solutions offered. Patient-centredness Social changes in relationships between professionals and the public and in access to and use of information, along with increased public awareness of medical errors, raised by several high profile media cases, have led to more sceptical, empowered and questioning patients. Patients expect to be given information about their condition and treatment options, and to be involved in decision making about their care.5 Patients are most concerned about health professionals': respect for their values, preferences and expressed needs; coordination and integration of their care; provision of information and education; assistance in their physical comfort (including pain management); provision of emotional support, and alleviation of their fears and anxieties; involvement of their families and friends; facilitation of the continuity and transition of their care; and assurance of their access to care when they need it. …