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Speaking up about safety concerns: multi-setting qualitative study of patients' views and experiences
  1. Vikki A Entwistle1,
  2. Dorothy McCaughan2,
  3. Ian S Watt3,
  4. Yvonne Birks4,
  5. Jill Hall5,
  6. Maggie Peat6,
  7. Brian Williams7,
  8. John Wright8,
  9. for the PIPS (Patient Involvement in Patient Safety) group
  1. 1Social Dimensions of Health Institute, University of Dundee, Dundee, UK
  2. 2Department of Health Sciences, University of York, York, UK
  3. 3Department of Health Sciences, University of York and Hull York Medical School, York, UK
  4. 4Department of Health Sciences, University of York, York, UK
  5. 5Department of Health Sciences, University of York, York, UK
  6. 6Harrogate and District Foundation NHS Trust, Harrogate District Hospital, North Yorkshire, UK
  7. 7Social Dimensions of Health Institute, University of Dundee, Dundee, UK
  8. 8Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
  1. Correspondence to Vikki A Entwistle, Social Dimensions of Health Institute, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK; v.entwistle{at}


Objectives To explore patients' and family members' experiences of and views about speaking up about safety concerns at the point of care.

Design Qualitative study using 71 individual interviews and 12 focus group discussions.

Participants and settings People with recent experience of one of five conditions or interventions associated with different safety problems (childhood asthma, diabetes, breast cancer, elective joint replacement and severe and enduring mental health problems) and people who had lodged concerns with healthcare providers were recruited from both NHS services (primary and secondary care) and patient support organisations.

Findings Participants had identified various safety concerns in the course of their healthcare and had sometimes spoken up about these as they occurred. Their inclination and ability to speak up were apparently variously shaped by their assessments of the gravity of the threat of harm, the relative importance of their concern given other patients' needs and staff workloads and priorities, their confidence about their grounds for concern, roles and responsibilities and the likely consequences of speaking up. These assessments were pervasively influenced by the way healthcare staff behaved and related to them. People who had spoken up about concerns reported diverse responses from health professionals. Some responses averted harm or provided welcome reassurance, but others exacerbated anxieties and possibly contributed to patient harm.

Conclusion The potential for patients to contribute to their safety by speaking up about their concerns depends heavily on the quality of patient–professional interactions and relationships.

  • Patient safety
  • patient participation
  • professional–patient relations
  • communication
  • qualitative research
  • quality of care
  • safety culture

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  • The PIPS group comprises the authors of this paper plus Simon Gilbody (University of York), Su Golder (University of York), Peter Mansell (formerly with National Patient Safety Agency) and Trevor Sheldon (University of York).

  • Funding This study was funded by the Department of Health Patient Safety Research Programme (PSRP PS/034). Vikki Entwistle's post is part-funded by the Chief Scientist Office of the Scottish Government Health Department, NHS Education Scotland and the Scottish Funding Council (via the Alliance for Self-Care Research). The funders played no role in data collection or analysis, and the authors have prepared this manuscript independently of the funders.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Bradford NHS Research Ethics Committee (ref. 06/Q1202/88).

  • Provenance and peer review Not commissioned; externally peer reviewed.