What theories might inform interventions to assist patients and carers in improving patient safety in primary care?

10 Dec

by Gavin Daker-White, GM PSTRC Research Fellow for Multimorbidity theme

Robbie Foy and others consider the role of theory in evaluating “the implementation of patient safety practices” [1]. They note that patient safety research has tended to be atheoretical, which limits the generalisability of findings to different settings. Using the example of handwashing by hospital staff, they suggest that “patient safety practices” might include behavioural, systems or organisational components. The article raises some interesting questions related to the research program within the Multimorbidity theme, which will in part explore the ways in which patients or patient-carer dyads might become more engaged or involved in patient safety work themselves. Foy et al. identify the types of theories that might be relevant in terms of interventions in clinical settings [1]. Diffusion of innovation theory, developed by Everett Rogers in the 1960s offers one possibility. Another useful framework is offered by the theory of change, as used in implementation research generally and described by Mary Dixon-Woods et al. in the specific context of patient safety research [2]. Foy et al. also refer to theories of human error and the theory of planned behaviour [1]. Attempting to change patient or carer behaviour, e.g. through provision of information and changing ‘cultural expectations’ around health care, does appear cogent with attempts’ to change the behaviour of health care workers. However, within a self-management perspective, where patient behaviour is rooted in social context and connections, is a ‘systems’ approach the best way of conceiving of interventions that might help patients to be alerted to safety issues themselves? An alternative theoretical approach that may be more relevant is offered by one that considers informal knowledge sharing. This approach has also been used in clinical settings, notably a UK-based ethnographic study of “water cooler learning” about patient safety in the “backstage” of day case surgery units [3]. From qualitative studies of patient safety in primary care, we know that errors of access and in patient-physician relationships may be more important than the technical errors that characterise hospital-based studies and interventions (e.g. [4]). In light of “water cooler learning,” it is also useful to consider whether informal and/or ‘formal’ (e.g. within clinical encounters) strategies are likely to be the most useful. Within a social networks perspective, attention to ‘informal’ or lay networks might also be a potential means of ‘diffusing’ innovations concerning patient safety in primary care through society more widely. References

  1. Foy R, Overtveit J, Shekelle PG et al. (2011) The role of theory in research to develop and evaluate the implementation of patient safety practices. BMJ Qual Saf 20: 453-459.
  2. Dixon-Woods M, Tarrant C, Willars J et al. (2010) How will it work? A qualitative study of strategic stakeholders’ accounts of a patient safety initiative. Qual Saf Health Care 19: 74-78.
  3. Waring JJ and Bishop S (2009) “Water cooler” learning: Knowledge sharing at the clinical “backstage” and its contribution to patient safety. Journal of Health Organization and Management 24: 325-342.
  4. Kuzel AJ, Woolf SH, Gilchrist VJ et al. (2004) Patient reports of preventable problems and harms in primary health care. Annals of Family Medicine 2: 333-340.

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