Title: Improving patient safety through the involvement of patients
Funder: Department of Health (England)

Abstract: Aims:This programme will design, develop and evaluate four innovative approaches to engage patients in preventing patient safety incidents (PSI): 1. Assessing risk 2. Reporting incidents 3. Direct engagement in preventing errors 4. Education and training Background: Estimates suggest that in NHS hospitals, incidents causing harm to patients occur in 10% of admissions with costs to the NHS of over £2 billion. Strategies to reduce PSI have focused on changing systems of care and professional behaviour. More recently, there has been an international drive to involve patients in safety initiatives, despite little evidence on how best to achieve this. Recent reviews of the literature have highlighted: a lack of initiatives to promote patient/carer involvement in patient safety; major gaps in our knowledge about the nature and effects of patient involvement; little evidence of the feasibility or effectiveness of patient centered interventions; and uncertainty over their acceptability Research Plans 1. Assessing risk: Patient measure of organisational safety: Organisational failures are easier to diagnose and manage pro-actively than individual errors. Measurement tools (eg Shell’s TRIPOD) have been developed in high-risk industries to monitor organisational safety and the applicants have developed a pro-active error management tool for health care. However these tools include little or no consideration of user’s views. This project will develop and validate a patient-completed measure of organisational safety. Phase 1: Qualitative methods to develop the measure and testing of validity and reliability. Phase 2: After a pilot study at one Trust to integrate the measure into clinical governance systems we will undertake a larger study adopting a stepped wedge design to evaluate the use of the measure to promote organisational learning in 5 NHS trusts. Qualitative and quantitative outcomes will be assessed. 2. Reporting incidents: Patient-based error reporting system: Patients are ideally placed to report errors in their care yet are rarely involved in reporting or learning systems This project will build on our expertise in error reporting and patient involvement in safety to develop and evaluate a patient-based reporting and learning system. Phase 1: An initial exploration of attitudes and methods for involving patients in reporting of errors will be undertaken using interviews and focus groups with patients and professionals. We will evaluate the volume and quality of reports from 3 different reporting mechanisms in 3 clinical settings and compare with the prevalence of PSI from case note review and routine reporting. Phase 2: Piloting and evaluation: As project 1. 3. Direct engagement: Promoting patient involvement in improving safety: We will use the MRC framework for complex interventions to develop, test and undertake an exploratory trial of a patient-centred intervention targeted at improving safety in three priority health areas: medication errors, infection control and clinical deterioration. Phase 1: Evidence collation: updating systematic reviews and qualitative research to obtain the views, perspectives and experiences of patients and professionals and inform the development of a draft intervention. Phase 2: iterative development and refinement. Testing and refining the intervention in an iterative process with patients and staff. Phase 3: An exploratory trial in 2 hospital sites leading to a tested and refined patient-centred safety intervention and a definitive RCT protocol. 4. Education and training: A patient-centred training programme to improve patient safety: Early development and field testing of an innovative patient-centred training programme to improve safety using the feedback of patient experiences of error is being completed and we will evaluate the programme using a randomised cluster trial. Foundation Year doctors based in two schools will receive either no intervention or a training programme based on patient narratives to improve safety awareness and attitudes. Qualitative (acceptability, benefits, concerns, unintended consequences) and quantitative methods will be used to evaluate the impact of the intervention. Research Team: This multi-disciplinary team is based on an established and successful collaboration between NHS professionals and academics. The programme will be based at the Bradford Institute of Health Research Outputs: 1) A validated patient measure of organisational safety. 2) A patient-centered reporting and learning system. 3) An intervention to support patients to work collaboratively with professionals to reduce error. 4) A patient-led safety training programme to improve safety awareness and attitudes in health care professionals. Patient involvement is the focus of this applied programme and patients will be central in co-designing and developing the programme.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE