Patients view errors more broadly than clinicians
Understanding patients' perceptions is a must
Even though you may be meeting all of your clinical guidelines for preventing errors, your patients may not necessarily share your assessment that things are going well. A new study in the Joint Commission Journal on Quality and Patient Safety reveals that patients have a much broader definition of medical errors than clinicians.1
For example, notes the study, patients' definition of medical errors included not only clinical mistakes but patient falls and staff not communicating effectively or not being responsive to patient requests. The study, which surveyed patients discharged from 12 Midwestern hospitals, found that while 94% believed their medical safety had been good to excellent, 39% experienced at least one error-related concern.
The study was part of a larger grant from the Agency for Healthcare Research and Quality, explains Thomas E. Burroughs, PhD, lead author and director of the Center for Outcome Research, St. Louis University.
"We wanted to learn what patients are concerned about, what behaviors should be part of precautions against errors, and what they should do in talking with providers," he notes. "This particular study looks at how they view their health care experience from the perspective of the risk of having various types of medical errors happen to them."
In a series of focus groups, he continues, the patients were asked to describe what the term "medical errors" means, "and what might lead them to develop certain viewpoints."
Expanding the definition
One of the things that became instantly apparent, says Burroughs, is that when patients thought about patient safety and medical errors, they "expanded beyond traditional clinical medical definitions." This expansion, he adds, included communication, coordination of care, and the way in which they were treated as people.
"They talked about things that in a way made some sense in regard to errors," he offers. "If a doctor or nurse is not speaking clearly with a patient about how they need to care for themselves, or prepare for a procedure, they may not understand the provider and may be less likely to do what they need to do. Yet, as a clinician, you often don't think about those things in terms of errors or safety."
Where the "rubber meets the road," he says, is whether a patient feels safe. "It's important to realize that when we use certain language, the patient may not interpret it the way we mean it," Burroughs emphasizes. For example, he notes, if you are seeking to engage patients in programs that help them reduce their risks, and you only talk about keeping track of their meds, or noting if providers are washing their hands, "you may not be going far enough."
This confusion, he says, might lead to odd provider/patient conversations. "You might, for example, ask the patient to tell you any time they think something is happening that puts them at risk, but when they come and talk to you about coordination of care, you might think they are talking about service," Burroughs offers. "But they think they are doing what you asked. On the other hand, if we talk about the risk of errors and don't talk about things like communication and coordination of care, it may seem to the patient that we are missing a big part of what they consider to be medical errors."
Satisfaction impact
Failing to recognize these important patient perceptions can be a big issue if you are seeking to improve patient satisfaction, says Burroughs. "It's important to know what the patient's definition of safety includes," he says. "If that information is being used to launch structural and process changes to improve safety, it makes some sense to improve communication and coordination."
Along those lines, it's also important for the hospital staff to recognize that the age of the patient has a lot to do with a patient's — and family's — perceptions of safety. "There's a pretty clear distinction by ages," Burroughs asserts. "For example, parents of pediatric patients are more concerned about patient safety than anyone else. There was a significant drop [in concern] by patients in their 20s, but then it rose considerably for patients in their 30s and 40s; then it dropped again."
It's important to remember that fears and concerns may be very different for different patients, he continues. "Older patients may come in with a much safer feeling than patients in the 30 - 50 range," says Burroughs.
That also can be an important consideration when engaging a patient in an error prevention program. "Normally, you might tell the patient they need to make sure their meds match what they expect to receive, that they should ask staff if they are washing their hands, and so forth," he offers. "But for patients in their 60s to their 80s, it may be disturbing to them because they may not have previously felt they were at risk, because it did not coincide with the way they look at the health care experience."
For parents, on the other hand, it's critical to help put them at ease. "Explain the checks and balances, and tell them what they can do to help you put their child at less risk," he concludes.
Reference
1. Burroughs TE, Waterman A, Gallagher TH, Waterman B, Jeffe DB, Dunagan WC, Garbutt J, Cohen MM, Cira J, and Fraser VJ. Patients' Concerns About Medical Errors During Hospitalization. Journal on Quality and Patient Safety; January 2007, Vol 33; No 1: 5-13.
Source
For more information, contact:
- Thomas E. Burroughs, PhD, Director, Center for Outcome Research, St. Louis University, St. Louis, MO. Phone: (314) 977-9420.
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