Optimizing Patient Safety Through System Strategies and Patient Engagement

By Paul Rooprai and Neel Mistry

Patient safety can be defined as the absence of preventable injuries arising from the process of healthcare. Including patients in clinical discussions is central to patient safety, and this can be accomplished by patient-centered decision-making, establishing a culture of safety, and effective communication and teamwork.

Patient engagement is important to promote safety in healthcare, and patient-centered decision-making is a central means to facilitate this engagement. There are several clinical trials suggesting that engaged patients have a significant mortality reduction (Darkins et al., 2015; Darkins et al., 2008). Activated and engaged patients who collaborate with their clinician are likely to have better health outcomes. A collaborative relationship is intended to help patients manage their conditions and stay healthy; make better health-related decisions; and become more interested in their ongoing care. Providers should be respectful and responsive to patients’ preferences, needs, and values and ensure that these aspects guide all medical decisions. The need for patient engagement is foundational as the majority of individuals spend only a small proportion of their time in medical facilities and frequently must make daily health decisions on their own. Further, patient engagement has an ethical basis: Engagement supports patient autonomy, promotes trust in the physician-patient relationship, and helps to set reasonable expectations and improve knowledge. A practical need for engaging patients exists as well. Almost all medical decisions inherently have a trade-off of harms and benefits. A good decision can be made by including the patient’s values and preferences. Patients themselves must engage in behavior change and health management. Without an understanding of care and buy-in, patients are less likely to manage their health effectively. Case studies in diverse medical settings show resulting improvements in healthcare quality and outcomes when patients are engaged (Laurance et al., 2014). These findings demonstrate how engagement can shift the paradigm from “what is the matter?” to “what matters to you?” Ultimately, patient participation in healthcare decision-making has clear benefits such as better adherence to treatment plans, higher levels of satisfaction with care, and improved health outcomes.

Healthcare today is complex, highly efficient, and costly. Due to this inherent complexity, there is a need for the establishment of a culture that encourages safety at the system and individual level (Taran, 2011). With the tests and procedures that are conducted today in addition to the intricacy of the system, healthcare can cause harm. Errors can be the result of recklessness at the individual level. But it is also important to recognize that they are caused by faulty processes, systems, and other circumstances that lead to mistakes or fail to prevent them. The number of errors can be reduced by redesigning the medical system at all levels to improve safety. Through a broad lens, this system must have practices that address the following: 1) error prevention; 2) detecting errors as they arise so they can be intercepted; and 3) reducing the effects of errors that go undetected. A culture of safety is a necessity. Such an environment would involve workers who accept responsibility for the safety of not only themselves, but also their coworkers and patients. In this culture, safety is prioritized above operational and financial goals. Leaders support and reward identification of errors, open communication, and resolution of issues surrounding safety. They ensure that the organization learns from accidents and provide the resources, accountability, and structure to maintain successful safety systems. Overall, the novel safety culture emphasizes learning each time an error occurs. The strategy is to identify failures at the system and individual level within a safe environment that encourages reporting.

Physicians can work with patients to improve safety in healthcare by being effective communicators and collaborators. Failure in communication can do more than hamper safety—it can erode trust in care providers, reduce the quality of care delivered, and result in poorer health outcomes (McGlynn et al., 2003). Physicians have the responsibility to present a balanced overview of medical options. This is important as objective and complete information empowers patients to make informed decisions in line with their preferences; however, providing this depth of information may be difficult due to barriers such as time constraints. To address this issue, beyond taking additional training to learn how to better communicate, doctors can provide patients with decision aids—supplemental decision-support material. It is important that the information being used to generate these decision aids be complete, unbiased, and understandable by a wide range of people. There is now considerable evidence, based on more than 50 randomized trials, that when high-quality decision aids are available, patients are more informed and participate more in decision-making (Stacey et al., 2017). Using decision aids alone, however, is not enough. It is also necessary to have a physician-patient interaction that incorporates the patients’ concerns and goals into the decision-making process. Communication goes hand in hand with teamwork and is just as essential in ensuring patient safety. Teamwork is a skill that often needs to be learned, and literature highlights the importance of team training in realizing improvements in patient safety and communication (Barach & Small, 2000). The skills acquired through team training can be taught using various techniques, including simulation strategies that can measure team competency (Zheng et al., 2008). A simple way of introducing team-centered activity and skills into healthcare settings is by training doctors as a team around completing specific tasks. Also referred to as “task-tailored training,” this type of training can be effective for numerous processes that take place in hospitals (e.g., handovers, surgical procedures, clinical rounds) (Johns et al., 2009).

In conclusion, health systems and doctors should strive to maintain patient safety by promoting patient-centered approaches, establishing a culture of safety, and improving physician relationships by facilitating communication through team structures. Ultimately, patient engagement is an integral component of patient safety, and physicians must work with their patients in order to support this.

Paul Rooprai is a medical student at the University of Ottawa who is passionate about evidence-based medicine, clinical research, and patient safety. Neel Mistry is a medical student at the University of Ottawa who is passionate about medical education, public policy, and health management.

References

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Darkins, A., Kendall, S., Edmonson, E., Young, M., & Stressel, P. (2015). Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: A retrospective matched cohort study of 4,999 veteran patients. Telemedicine and e-Health, 21(1), 70­–76. https://doi.org/10.1089/tmj.2014.0067

Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., & Lancaster, A. E. (2008). Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14(10), 1118–1126. https://doi.org/10.1089/tmj.2008.0021

Johns, M. M., Wolman, D. M., & Ulmer, C. (Eds.). (2009). Resident duty hours: Enhancing sleep, supervision, and safety. National Academies Press. https://doi.org/10.17226/12508

Laurance, J., Henderson, S., Howitt, P. J., Matar, M., Al Kuwari, H., Edgman-Levitan, S., & Darzi, A. (2014). Patient engagement: Four case studies that highlight the potential for improved health outcomes and reduced costs. Health Affairs, 33(9), 1627–1634. https://doi.org/10.1377/hlthaff.2014.0375

McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 2635–2645. https://doi.org/10.1056/nejmsa022615

Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., & Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd001431.pub5

Taran, S. (2011). An examination of the factors contributing to poor communication outside the physician-patient sphere. McGill Journal of Medicine, 13(1), 86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277343/

Zheng, B., Denk, P. M., Martinec, D. V., Gatta, P., Whiteford, M. H., & Swanström, L. L. (2008). Building an efficient surgical team using a bench model simulation: Construct validity of the Legacy Inanimate System for Endoscopic Team Training (LISETT). Surgical Endoscopy, 22(4), 930–937. https://doi.org/10.1007/s00464-007-9524-1