Patient and caregiver engagement in medical treatment can promote safety. This scoping review explored the qualitive research regarding how patients and caregivers engage in safety during cancer treatment. Four themes were identified – patient perception and involvement in safety; patient engagement in their care; safety as a collective responsibility; and the importance of caregivers relative to the amount of support they receive.

Team reflexivity represents the way individuals and team members collectively reflect on actions and behaviors, and the context in which these actions occur.  This systematic review identified 15 studies describing the use of team reflexivity within healthcare teams. Included interventions, most commonly simulation training  and video-reflexive ethnography, focused on the use of reflexivity to improve teamwork and communication. However, methodological limitations of included studies precluded the authors from drawing conclusions around the impact of team reflexivity alone on teamwork and communication.

This qualitative study compared four high-performing geriatric inpatient units with four average-performance units in order to understand factors that contribute to high performance. The authors conclude that the safety practices did not differ between the high versus average performers. Instead, optimal teamwork and positive safety culture led the high-performing wards to implement these safety practices in a more effective way.

Patients' reports of safety concerns can reveal adverse events that would not be identified otherwise. In this cluster-randomized trial of patient engagement, patient volunteers read and classified incident reports submitted by hospitalized patients enrolled in the study. Following classification by patients, reports underwent a standardized, validated review by multiple researchers to determine if the event constituted a patient safety incident. Overall, about one-third of patient-reported concerns were deemed to be patient safety incidents. Medication safety issues were the most prevalent concerns. The authors conclude that patient reporting of safety events lends a unique and necessary perspective to error reporting. A previous PSNet perspective highlighted the advantages to and limitations of engaging patients in patient safety.

This study evaluated the implementation of a patient safety intervention. Frontline staff engagement with the intervention was highly variable and the intervention was not implemented as intended across the study sites. These results underscore the challenge of translating patient safety research into practice.

Although patient engagement is widely recommended as a patient safety strategy, its impact on patient outcomes is unclear. In this cluster randomized trial, hospital wards were designated either to receive usual hospital care or to engage patients in safety by providing a questionnaire and an opportunity to report their positive and negative safety experiences. Investigators compared a global measure of safety, which included pressure ulcers, venous thromboembolism, catheter-associated urinary tract infections, and falls, between wards that engaged patients through this intervention with those that did not. While the participating hospital wards were able to collect safety feedback from patients in a feasible and acceptable manner, researchers found no statistically significant differences in safety outcomes in the patient engagement wards and the usual care wards. The authors conclude that evidence is insufficient to recommend this questionnaire-based patient engagement strategy as a way to enhance safety.

The role of patients in promoting their own safety remains controversial. Although some studies have shown that patients are able to identify errors not detected via other means, others have shown that patients may conflate service quality with safety issues. In this feasibility study, authors describe the development and testing of an intervention designed to collect feedback from hospitalized patients about the safety of their care.

… to raise concerns ) were successful. … Wright J, Lawton R, O'Hara J, et al. Health Services and Delivery Research. …

This systematic review explored studies of positive deviance, those with exceptional performance, in health care. Researchers found that the most common patient safety research topic using this approach to date is health care–associated infections. The authors suggest that more methodological rigor is needed to apply the approach to patient safety research more widely.

Patient engagement programs are being widely implemented as means of improving the safety and quality of hospital care, and prior studies have shown that patients can identify safety issues that go undetected by other methods. This study examined the relationship between patient and staff perception of safety and overall safety outcomes by comparing patient perceptions of safety (measured by the Patient Measure of Safety survey), staff perception of safety (measured by the AHRQ Hospital Survey on Patient Safety Culture), and quantitative measures of patient safety events (measured by the NHS Safety Thermometer). The investigators found that both Patient Measure of Safety and Hospital Survey of Patient Safety Culture results were correlated with objective measures of safety, and they appeared to contribute independently to predicting safety outcomes. This study provides further evidence for including patient perspectives in identifying and measuring safety issues.