“The patient is the single most important safety barometer” according to roundtable discussion



Patient safety has featured heavily in the news recently, with the Mid Staffordshire inquiry, childrens heart surgery in Leeds and the investigation into deaths of babies at Furness General Hospital.  It is a top priority for commissioners.  The Health Foundation recently published an evidence review Involving patients in improving safety (1).  This report follows a workshop held to build on the evidence review to consider some of the gaps in the evidence base, notably barriers and enablers to successfully involving patients and the public in efforts to improve patient safety.


Barriers and enablers

Patients have reported feeling subordinate to professionals

Patients have reported feeling subordinate to professionals

  • There is considerable variation in the structures and systems set up to engage with patients and the public, which may be due to the lack of mandated requirements.
  • It was suggested that patients and the public may not feel legitimised to raise safety issues and may feel “subordinate” to health care professionals.
  • There is an issue around ownership of patient safety issues; it was recommended that a role tasked with the overview of care or safety on each shift could be of benefit.
  • Compliance with safety requirements and the use of sanctions has been variable.  Generally, data tends to be quantitative rather than qualitative, for example, the number rather than the nature of complaints.  It was suggested patients could help audit and review complaints; it was also noted there remains a strong sense of discomfort about real time feedback due to patients’ concerns about the impact on their care.
  • It was noted that current engagement initiatives can be focused on particular services or patient groups rather than a generalised approach.  There is also an issue about timing, for example, engagement may be planned to coincide with discharge which may not be the best time for the patient.
  • Investment in patient leadership is patchy and there is variation across the local Healthwatch implementations.  A suggestion was made to continually refresh membership of patient groups to ensure a fresh perspective.
  • The report references research underway at Bradford Institute for Health Research where information on safety concerns is routinely captured and the staff and patient perspectives evaluated.
  • Transparency and publication of data, particularly performance information, is also considered and a potential role for commissioners, GPs and charities is mentioned, to help patients understand data.
Transparency and publication of data - role for commissioners

Transparency and publication of data – role for commissioners


Commissioners will find this briefing useful for the consideration of barriers and enablers to engaging patients and the public effectively in improving patient safety.  The evidence scan (1) published in January 2013 will provide wider context of the evidence relating to collecting feedback; involving patients in service change; and encouraging patients to raise issues when they are receiving care.

The findings from this roundtable discussion will feed into the Health Foundation’s work on patient safety; more information can be found at http://www.health.org.uk/areas-of-work/topics/patient-safety/.



Health Foundation (2013),  Involving people in safety. A summary of learning from a Health Foundation roundtable,



Supporting material

(1)    Health Foundation (2013), Evidence scan: Involving patients in improving safety, http://www.health.org.uk/publications/involving-patients-in-improving-safety/


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Alison Turner

I'm Head of the Evidence Analysis team within the Strategy Unit at NHS Midlands and Lancashire Commissioning Support Unit. I'm interested in how knowledge management can support value based healthcare and evidence based decision making. I've previously worked in a range of different healthcare settings, including acute care, commissioning, health services research and medical education. More recently, I worked at NHS Evidence and NHS Institute for Innovation and Improvement.

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