Rachel E. Davis

Patient involvement in patient safety: what factors influence patient participation and engagement?

Background Patients can play an important role in improving patient safety by becoming actively involved in their health care. However, there is a paucity of empirical data on the extent to which patients take on such a role. In order to encourage patient participation in patient safety we first need to assess the full range of factors that may be implicated in such involvement.

Patients and families as safety experts

See related research article by Daniels and colleagues on page [29][1] and at [www.cmaj.ca/lookup/doi/10.1503/cmaj.110393][2] Patient safety is addressed and discussed from many perspectives. Lessons are sought from all manner of industries and experts, from the disciplines of psychology,

Patients’ attitudes towards patient involvement in safety interventions: results of two exploratory studies

Background  In recent years, patient‐focused interventions have been introduced aimed at increasing patient involvement in safety‐related behaviours. However, patients’ attitudes towards these interventions and comfort in participating in the recommended behaviours remain largely unexplored.

Is team training in briefings for surgical teams feasible in simulation

We developed a module for surgical team training using briefings in simulated crisis scenarios and here we report preliminary findings. Nine surgical teams (34 trainees) participated in a pre-training simulation, followed by an interactive workshop on briefing and checklists, and then a post-training simulation. Both technical and non-technical skills were assessed via observation during simulations by expert trainers who provided feedback on performances at the end of simulation. Trainees also reported their attitudes to briefings and evaluated the training. Pre-training attitudes to briefing were positive, some of which improved post-training and trainees’ evaluation of the training was positive. Surgeons’ technical skill improved significantly post-training, but their decision-making skill was rated lower than other non-technical skills, compared to other trainees. The training did not appear to greatly improve non-technical skill performance. Training surgical teams in simulation is feasible but much more work is needed on measurement development and training strategy to confirm its efficacy and utility.

A method for measuring work interference in surgical teams

To enhance surgical systems we need to manage the performance of the teams that comprise them. To do this we must measure the properties and processes of teams and account for the demands and conditions of their work. Recent research shows that observation is a potentially valuable method of measurement, but its potential application in surgery remains unclear. In this study of laparoscopic cholecystectomy, an observer applied observational measures of teamwork in the operating theatre and recorded intra-operative interference from observed distraction and interruption. Results showed that it was feasible to observe a broad scope of teamwork and to reveal the frequency and source of work interference. However, the measures were necessarily selective and so limited in their analysis of the conditions and events that might interfere with the collective work in surgery. Such measures may however prove useful when applied in conjunction with other methods of measurement and utilised as performance feedback data.

Predictors of Patients' Intentions to Participate in Incident Reporting and Medication Safety.

Background To date, there is a paucity of theory-driven research on the likely determinants of patient involvement in safety-relevant behaviors. In particular, very little work has focused on predictors of patient behaviors that do not involve direct interactions with health-care staff. Objective To examine predictors of patients’ intentions to engage in 2 safety behaviors: (1) reporting an error to a national reporting system and (2) bringing medicines into hospital. Design Cross-sectional survey study. Participants Eighty medical and surgical hospital inpatients aged 18 to 80 years (mean, 48 years) from one inner city London teaching hospital. Method Survey that measured the utility of constructs of the health belief model and theory of planned behavior in predicting patients’ intentions to report an error to a national reporting system or to bring their medications into hospital. Data were analyzed using multiple regression analysis. Results Control beliefs were the strongest predictors of patients’ intentions. Normative beliefs were also a strong predictor of intentions to report an error to a national reporting system. The regression model accounted for smaller percentage of the variance in patients’ intentions to bring medications into hospital than to report an error to a national reporting system (37% and 48%, respectively). Conclusions Interventions aimed at encouraging the participation of patients in promoting their own safety should consider the extent to which patients feel in control and capable of performing the behavior in question; this will help support patients to work with health-care professionals in ensuring safe care.

How the friends and family test is conveyed to the public should be reconsidered

In July 2013 the first data from the friends and family test (FFT) became publicly available on NHS Choices.1 Hospitals are given an FFT score and ranked “best,” “OK,” or “worst.” There are several problems about how these data are currently conveyed to the public. Firstly, no details are provided on how the FFT score is calculated, in particular that …

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of interventions designed to increase patient and family involvement in escalation of care for acute life-threatening illness on patient and family outcomes, treatment outcomes, clinical outcomes, patient and family experience and adverse events.