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Patient as a Team Member in Clinical Care

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    • Last Updated: October 25, 2023
    Created By: Lorri Zipperer, Cybrarian, and Dr. Kendall Hall, AHRQ PSNet Team
    Description
    This curated library highlights concepts associated with the patient as a partner for safety at the team level directly connected to personal clinical encounters.
    Library Organization
    Custom - This library is organized by custom section header names.
    Foundations (5)
    Patient Engagement and Safety

    Efforts to engage patients in safety efforts have focused on three areas: enlisting patients in detecting adverse events, empowering patients to ensure safe care, and emphasizing patient involvement as a means of... Read More

    TeamSTEPPS Core Curriculum.
    Rockville, MD: Agency for Healthcare Research and Quality; July 2023.

    The TeamSTEPPS® program was developed to support effective communication and teamwork in health care. The curriculum offers training for participants to implement TeamSTEPPS® in their organizations. The 3.0 version of the... Read More

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    The patient's role in patient safety.
    Corina I, Abram M, Halperin D. Obstet Gynecol Clin North Am. 2019;46:215-225.

    Patients and their families can play an important role in maintaining patient safety. This commentary provides clinicians with several tools on how to encourage patients to engage with their own safety and how to... Read More

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    Patient perceptions of missed nursing care.
    Kalisch BJ, McLaughlin M, Dabney BW. Jt Comm J Qual Patient Saf. 2012;38:161-7.

    Missed nursing care (failure to perform required patient care elements) is surprisingly common. This qualitative study found that patients were able to reliably identify episodes of missed nursing care and... Read More

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    All Library Content (19)
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    Review
    The patient's role in patient safety.
    Corina I, Abram M, Halperin D. Obstet Gynecol Clin North Am. 2019;46:215-225.
    Patients and their families can play an important role in maintaining patient safety. This commentary provides clinicians with several tools on how to encourage patients to engage with their own safety and how to effectively communicate with patients should an error occur.
    Study
    Encouraging patients to speak up about problems in cancer care.
    Mazor KM, Kamineni A, Roblin DW, et al. J Patient Saf. 2021;17:e1278-e1284.
    Patient engagement and encouraging speaking up can promote safety. This randomized study found that patients undergoing cancer treatment who were randomized to an active outreach program were significantly more likely to speak up and report healthcare concerns than patients in the control group.
    Study
    Classic
    Frequency and types of patient-reported errors in electronic health record ambulatory care notes.
    Bell SK, Delbanco T, Elmore JG, et al. JAMA Netw Open. 2020;3:e205867.
    This study surveyed over 22,800 patients across three health care organizations to assess how often patients who read open ambulatory visit notes perceive mistakes in the notes. The analysis found that 4,830 patients (21%) perceived a mistake in one or more notes in the past 12 months and that 42% of those patients considered the mistake to be somewhat or very serious. The most common very serious mistakes involved incorrect diagnoses; medical history; allergy or medication; or tests, procedures, or results. Older and sicker patients were more likely to report a serious error compared to younger and healthier patients. Using open notes and encouraging patient engagement can improve record accuracy and prevent medical errors
    Study
    Can patients contribute to safer care in meetings with healthcare professionals? A cross-sectional survey of patient perceptions and beliefs.
    Ericsson C, Skagerström J, Schildmeijer K, et al. BMJ Qual Saf. 2019;28:657-666.
    Patient engagement in safety is considered a best practice and a National Patient Safety Goal, but less is known about patients' perceptions regarding this topic. In this survey study involving 1445 patients in Sweden, researchers found that more than 80% of respondents felt comfortable directing questions to doctors and nurses. Patients who had filed a formal complaint reporting a safety concern were found to believe with greater certainty that the patient perspective can improve the safety of care.
    Study
    Emerging Classic
    Patient participation in patient safety—an exploration of promoting factors.
    Sahlström M, Partanen P, Azimirad M, et al. J Nurs Manag. 2019;27:84-92.
    This survey of medical inpatients at five academic medical centers in Finland aimed to elicit patients' perceptions of safety and experience of errors. Investigators found that encouragement from staff, education about patient safety, and comprehensible information all led to higher participation rates. The authors conclude that patients will be more engaged in their safety if frontline staff value patient involvement.
    Patient Engagement and Safety
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    • Efforts to engage patients in safety efforts have focused on three areas: enlisting patients in detecting adverse events, empowering patients to ensure safe care, and emphasizing patient involvement as a means of improving the culture of safety.
    Study
    Perspectives on patient and family engagement with reduction in harm: the forgotten voice.
    Schenk EC, Bryant RA, Van Son CR, et al. J Nurs Care Qual. 2019;34:73-79.
    Patients and families enhance safety when invited to express concerns and provide feedback about their care. Qualitative interviews of hospital staff, patients, and families highlighted both patients' and families' unique skills as safety advocates as well as barriers to speaking up. An Annual Perspective delineates tools to promote patient engagement in safety.
    Study
    Emerging Classic
    Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.
    Khan A, Spector ND, Baird JD, et al. BMJ. 2018;363:k4764.
    Patient engagement in safety takes many forms: patients may report unique safety incidents, encourage adherence to best medical practice, and coproduce improvement initiatives. Family-centered rounding in pediatrics invites families to express concerns, clarify information, and provide real-time input to the health care team. This pre–post study explored the safety impact of Patient and Family Centered (PFC) I-PASS rounds on 3106 admissions in pediatric units at 7 hospitals. Family-centered rounds reduced both preventable and nonpreventable adverse events. They also improved family experience without substantially lengthening rounding time. A past PSNet interview discussed the safety benefits of structured communication between health care providers and family members.
    Review
    Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review.
    Albutt AK, O'Hara JK, Conner MT, et al. Health Expect. 2017;20:818-825.
    This systematic review examined whether patient and family member activation of rapid response teams improved recognition of clinical deterioration. Studies demonstrated that patients and family members did not overwhelm rapid response capacity with frequent activations, but they did activate rapid response to convey concerns beyond clinical deterioration. The authors suggest further study is needed to determine how to best engage patients and families to detect clinical deterioration early.
    Study
    Patient perceptions of missed nursing care.
    Kalisch BJ, McLaughlin M, Dabney BW. Jt Comm J Qual Patient Saf. 2012;38:161-7.
    Missed nursing care (failure to perform required patient care elements) is surprisingly common. This qualitative study found that patients were able to reliably identify episodes of missed nursing care and their perceptions correlated with nurses' opinions.
    Study
    Classic
    Parent-reported errors and adverse events in hospitalized children.
    Khan A, Furtak SL, Melvin P, et al. JAMA Pediatr. 2016;170:e154608.
    Whether patient and family understanding of safety issues aligns with standard definitions of medical errors is unclear. In this study, parents of pediatric inpatients were asked if their children experienced any safety incidents during hospitalization. Physician reviewers evaluated parents' reports and designated incidents as errors or quality issues or excluded them. Just under 10% of respondents reported an incident, and 62% of these were confirmed by the study team as medical errors, with the remainder considered either quality issues or exclusions. Consistent with prior studies, many of the confirmed errors were not captured in the medical record. This work demonstrates that allowing patients and families to report safety concerns can identify previously unknown errors. A recent PSNet perspective calls for enhanced patient engagement in safety.
    Study
    A patient feedback reporting tool for OpenNotes: implications for patient–clinician safety and quality partnerships.
    Bell SK, Gerard M, Fossa A, et al. BMJ Qual Saf. 2016;26:312-322.
    Enhancing patient engagement is a priority for patient safety efforts. This quality improvement study drew from the OpenNotes project, in which patients are given access to electronic clinician documentation. Patients were asked to provide feedback and note any inaccuracies, omissions, or safety concerns in a reporting tool. As with prior studies of OpenNotes, a minority of patients elected to read the documentation; of those, the majority did not provide feedback to clinicians. The study team's clinician review panel assessed patient concerns and shared reports deemed to be safety issues with the clinicians who wrote the notes. About one quarter of patient feedback reports were considered safety concerns, and more than half resulted in the clinician making a change to the health record. The authors conclude that patient feedback on clinical notes can improve documentation and enhance detection of safety hazards.
    Study
    Engaging the patient as observer to promote hand hygiene compliance in ambulatory care.
    Bittle MJ, LaMarche S. Jt Comm J Qual Patient Saf. 2009;35:519-25.
    Efforts to address poor provider hand hygiene rates have escalated in the setting of increased attention to health care–associated infections. Along parallel lines, the importance of patient engagement was elevated by its introduction into the National Patient Safety Goals. This pilot study adopted a tool to engage patients in auditing provider hand hygiene rates in the ambulatory setting. Investigators found that patients were largely willing to monitor and report on providers' compliance with hand hygiene and did not feel it impacted their patient–provider relationship. Patient observations correlated well to independent direct observations of hand hygiene rates, suggesting that this type of engagement may be efficient and acceptable.
    Multi-use Website
    Guide to Patient and Family Engagement in Hospital Quality and Safety.
    Rockville, MD: Agency for Healthcare Research and Quality; June 2013.
    Studies have shown that a surprisingly large proportion of hospitalized patients are not aware of their diagnoses or treatment plan and that their preferences are often not taken into account in advanced care planning. This failure to provide patient-centered care indicates a need for increased patient engagement in safety and quality efforts. This toolkit published by the Agency for Healthcare Research and Quality is designed to help hospitals develop partnerships with patients around improving safety. Developed with input from clinicians and patients, the guide emphasizes four strategies—working with patients as advisors, improving bedside communication, integrating patients and families into shift changes, and using patient input to improve the discharge process. An AHRQ WebM&M perspective by Dr. Saul Weingart discusses the practical challenges of engaging patients in improvement efforts.
    Course Material/Curriculum
    TeamSTEPPS Core Curriculum.
    Rockville, MD: Agency for Healthcare Research and Quality; July 2023.
    The TeamSTEPPS® program was developed to support effective communication and teamwork in health care. The curriculum offers training for participants to implement TeamSTEPPS® in their organizations. The 3.0 version of the material has an increased focus on patient engagement and a broader range of clinical, administrative and leadership roles. The course includes updated evidence reviews, trainer guidance, measurement tools, a pocket guide quick reference to keyTeamSTEPPS® concepts and tools, and new patient videos.
    Review
    Patient engagement in the inpatient setting: a systematic review.
    Prey JE, Woollen J, Wilcox L, et al. J Am Med Inform Assoc. 2014;21:742-750.
    Patients are increasingly encouraged to take an active role in their own safety during hospital care. Some have criticized this strategy for shifting responsibility for patient safety. AHRQ, The Joint Commission, and other organizations have developed resources for patients to help prevent medical errors. This review identified 17 studies exploring the use of health information technology to increase patient engagement during inpatient care. Interventions ranged from efforts focused purely on engaging patients through entertainment to providing sophisticated personalized decision support. The authors conclude that the current literature leaves considerable gaps in knowledge regarding patient engagement in the hospital setting. A recent AHRQ WebM&M perspective discussed the opportunities and limitations of involving patients in safety.
    Review
    Classic
    Engaging patients as vigilant partners in safety: a systematic review.
    Schwappach DLB. Med Care Res Rev. 2010;67:119-148.
    The tenets of patient-centered care call for ensuring that clinical decisions are guided by a true partnership with patients. Patient safety is no different, and The Joint Commission called for hospitals to engage patients in safety efforts as a 2009 National Patient Safety Goal. This systematic review critically evaluates the published literature on patients' attitudes toward involvement in safety efforts and the effectiveness of such efforts. Overall, patients have a positive attitude toward engaging in safety programs, but some studies have found reluctance to engage in behavior that may seem confrontational toward providers. Although patient engagement in safety efforts should be encouraged and continues to increase, the authors note a lack of rigorous studies evaluating the effect of such efforts on safety outcomes.
    Commentary
    Classic
    Healthcare in a land called PeoplePower: nothing about me without me.
    Delbanco T, Berwick D, Boufford JI, et al. Health Expect. 2001;4:144-50.
    This viewpoint presents a summary of recommendations from the 1998 Salzburg Seminar entitled “Through the Patient’s Eyes.” The purpose of this seminar series is to offer a neutral forum for discussing beliefs on a variety of topics. The 5-day seminar was attended by 64 individuals from 29 different countries with a mission to create a health care system for a mythical republic called PeoplePower. The premise builds on a principle of “nothing about me without me,” as teams of health professionals, patient advocates, artists, reporters, and social scientists established a conceptual model. The authors share the participants’ visions of an ideal clinician-patient relationship and the role hospitals, national and local governmental agencies, and communities play in supporting such a model. Although they conclude that their health care system remains detached from financial, historical, and societal restraints, the principles serve as reminders that health programs must draw closer together patients and those who care for them.
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