Patient involvement in measuring and monitoring patient safety in general practice
Date
2022-07-01Author
Madden, Caoimhe
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Abstract
Given their unique viewpoint at the epicentre of the care process, patients can make
a unique contribution to improving our understanding of safety in general practice.
Despite this, patients remain an underutilised resource in the measurement and
monitoring of safety. Therefore, this thesis aimed to: (1) identify an approach to how
patients can contribute to the measurement and monitoring of safety climate; and (2)
ascertain the value of patient data for identifying and learning from past harm in
general practice. These were addressed through the conduct of a systematic review
and three empirical studies.
Study One comprised a systematic review of existing patient-report safety
climate measures in healthcare and provided an assessment of their psychometric
properties and coverage of safety climate domains. Issues were identified with
validity, reliability, usability and a lack of agreement on the appropriate safety
climate domains.
Study Two described the development and evaluation of a novel, patientreport measure of safety climate for general practice. Five distinctive factors
pertaining to safety climate were identified, and the measure was found to be both
valid and reliable.
Study Three examined the application of this novel measure, to evaluate the
patient perceptions of safety climate in Irish general practice and explore whether
these perceptions differ according to patient characteristics. It was found that
respondents generally reported positive perceptions of safety- although over twothirds of free-text responses related to ‘poor’ SC practices.
Study Four examined the value of utilising a qualitative approach to assess
past harm via ‘patient stories’, resulting in rich descriptions about safety deficiencies
in general practice. Findings confirmed that patients provide additional and unique
information about safety outcomes often unrecognised by healthcare professionals.
This thesis has established that patients are a valuable source of information
about safety in general practice, thus a concerted effort to effectively utilise this
evidence in the emerging field of patient involvement in healthcare is recommended.