From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.
An article in the March/April 2010 Patient Safety and Quality Healthcare Magazine by Andrea C. Scobie and D. David Persaud titled, “Patient Engagement in Patient Safety:Barriers and Facilitators” examines the impact of patient engagement in their own care on patient safety. Read more here.
The authors give examples of the technical issues in care provision (for example, patient identification, surgical site identification and wound management) that are essential to reduce adverse events and improve patient safety and point to recent studies that have begun to target the patient as an integral member of the care team with an ability to impact the reduction of medical errors.
One barrier to patient engagement, of interest to the field of conflict resolution, is:
Traditional Patient and Provider Roles
The traditional patient-provider relationship has also been identified as an impediment to greater patient participation in patient safety. Three major patient safety studies in the United States (Marella et al., 2007; Waterman et al., 2005; Davis et al., 2008) identified that patients feel less comfortable asking direct and confrontational questions of their providers, such as, “Did you wash your hands?” or asking if the physician could mark their surgical site. Davis et al. (2008) also found that patients are less willing to adhere to patient safety practices that they view as challenging to the healthcare staff’s clinical abilities. This was somewhat mitigated by the healthcare professional’s designation, with more individuals willing to ask challenging questions of nurses than of physicians.
Waterman et al. (2005) reported similar results with only 45.5% of the respondents indicating that they would feel comfortable asking medical personnel whether they had washed their hands. Even more shocking was the fact that only 4.5% of respondents actually did ask their care provider if they had washed their hands, indicating a large discrepancy between feeling comfortable to perform an error prevention action and actually performing that action. The traditional patient-physician relationship, in which the physician is perceived to have more knowledge about individual health concerns, is an impediment to patients asking questions of their physician, even if they feel that that their safety might be compromised and that they could play a role in preventing an error. This disconnect might point to broader cultural issues.
The authors provide a list of “Facilitators” to break down these barriers and encourage patients to engage in their care provision, with one example being:
One of the most commonly cited facilitators of patient engagement in patient safety is provider behavior or physician modelling. Patients are less likely to engage in behavior that they perceive to be confrontational or challenging. Davis et al. (2007) found that when patients were instructed by a doctor to ask challenging questions of themselves and nurses, patient willingness to ask was significantly increased. Thus, physician instruction and education surrounding the reasons why patients should ask questions may have a significant impact on patient error prevention behaviors.
Waterman et al. (2006) found similar results with their survey and suggest physician modelling as an integral part of patient education of patient safety practices. The authors propose that patient safety programs should target patient fears about challenging and insulting their healthcare provider by posting education material in hospital and waiting rooms encouraging patients to ask questions or having providers wear reminder buttons that encourage patients to ask them if they’ve washed their hands (Waterman et al., 2006). Fundamentally, provider modelling and education surrounding the acceptability of asking healthcare providers questions should ultimately lead to greater patient comfort in engaging in these behaviors. Hibbard et al. (2005) also suggest that training patients to be more assertive in their encounters with healthcare providers may lead to greater involvement in error prevention behaviors, as it has previously been shown to enhance patient involvement in their own care and improve care outcomes.
This article supports the National Patient Safety Foundation report on the need for medical schools to provide training in patient safety, conflict resolution, and communication skills. See more on our post here.
We welcome your comments on this topic.
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