Involving patients and carers in primary care patient safety: a qualitative study examining the role of a patient safety guide

Problem

Increasingly there is a recognition in health and social care that patients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This moves beyond asking patients to identify safety concerns and errors to work in partnership to prevent them. Co-design approaches have been used to develop, implement and evaluate participatory approaches in quality improvement initiatives in a variety of settings by working in collaboration with the end-users of the intended initiatives. In this project used a co-design approach to develop a primary care patient safety guide and aimed to identify processes that may influence its use and implementation into routine primary care, especially general practice and pharmacies.

Approach

A prototype of the primary care patient safety guide was developed using a co-design approach. After an initial brief scoping exercise of patient safety issues was conducted, a series of co-design events took place with a mix of GPs, pharmacists, patients and carers. During the events participants mapped the phases of care in relation to patient safety in priority areas, planned ways of improving patient safety at key points of care, and then worked together to refine the prototype of the guide. Following the co-design events, semi-structured interviews with 19 patients and carers were conducted to examine patients and carers existing strategies for patient safety and to evaluate the patient safety guide for patients and carers.

Findings

Participants identified both explicit and implicit issues of primary care patient safety that will influence involving patients and carers. The identification of shared priority areas and key patient safety questions, such as developing a shared understanding of patient safety, understanding each other’s role in safety, and to support collaborative improvement was important in creating a context in which patients could be involved in patient safety. To actively involve patients and carers in patient safety it was considered essential to consider the importance of communication, understanding roles and responsibilities, and developing partnerships between patients and healthcare providers. Factors affecting whether participants would make use of the guide related to engagement within and across services as well as uncertainties around how to embed it in clinical encounters such as consultations

Consequences

The patient safety guide will support patients and carers to partner with healthcare professionals to improve patient safety to address international and national priorities to improve patient safety. The co-design approach and in-depth qualitative study identified important areas where patient safety in routine primary care can be improved using patient and clinician experiences providing a more nuanced understanding of how patients and carers want to be involved in patient safety.