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Should patients have a role in patient safety? A safety engineering view
  1. Melinda Lyons
  1. Correspondence to:
 Dr M Lyons
 Department of Engineering, Engineering Design Centre, University of Cambridge, Cambridge CB2 1PZ, UK; mnl24{at}

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In recent years, there has been increased interest in involving the public to enhance the quality of care and improve the “patient experience” with a view to increasing their trust in the health system.1–3 Beyond giving their feedback on in-hospital experiences, several articles and reviews have considered how patients could play an active participant role in the safety of their own care processes.3–7 Examples of this role include researchers asking patients to verify with staff that they have washed their hands, or patients complying with instructions to mark the “non-surgical site” before surgery.6–8

However, based on experience of safety in other industries, it could be argued that relying on this type of patient participation should not be a solution worthy of long-term investment at the governmental level, but should rather be an unexpected source of help in its sporadic occurrence.

Although this issue has been discussed previously in health policy literature,9,10 there has as yet been no application of the knowledge of safety engineering from high-reliability industries to this issue.

For predominantly human-based systems in such industries, the field of “human factors” uses human reliability analysis (HRA) techniques such as HEART or THERP to define the attributes of a task, system or environment that would make it vulnerable to human error.

The HEART technique11 lists error-producing conditions (EPCs) such as the “familiarity of the task and the user’s experience with it”, “levels of supervision” and the “complexity of the task”.

The THERP technique12 identifies performance-shaping factors (PSFs) such as quality of the physical environment (noise, temperature and cleanliness); any presence of written procedures, team structure and communication. THERP also uses a large selection of “stressor PSFs” which may be psychological (presence of distractions) or physiological (fatigue, pain, discomfort, suffering from …

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  • Competing interests: None declared.

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