AHRQ Patient Safety Network - Patient Safety Primers

The Role of the Patient in Safety

Background

The traditional paternalistic model of medicine, in which patients have little voice in their care, has slowly but surely been evolving toward a model in which patients and clinicians work in a partnership toward the common goal of improved health. As articulated in the seminal Institute of Medicine report Crossing the Quality Chasm, such patient-centered care should be "respectful of and responsive to individual patient preferences, needs, and values and ensure that patient values guide all clinical decisions."

While many patient safety interventions have used traditional models of effecting change, such as changing provider behavior, encouraging interprofessional collaboration, and enhancing the culture of safety, the patient's role in safety has not been overlooked. The Joint Commission mandated that health care organizations "encourage patients' active involvement in their own care as a patient safety strategy" as a National Patient Safety Goal in 2007, catalyzing research into how patients may partner with providers to prevent errors—and how patients may themselves inadvertently precipitate errors.

Patients' Role in Preventing Errors

Efforts to engage patients in safety efforts have focused on three areas: enlisting patients in detecting adverse events, empowering patients to ensure safe care, and emphasizing patient involvement as a means of improving the culture of safety.

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.

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AHRQ Patient Safety Network - Patient Safety Primers