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What do patients and relatives know about problems and failures in care?
  1. Rick Iedema1,
  2. Suellen Allen1,
  3. Katherine Britton1,
  4. Thomas H Gallagher2
  1. 1Centre for Health Communication, University of Technology, Sydney, New South Wales, Australia
  2. 2University of Washington School of Medicine, Institute of Medicine, Washington, USA
  1. Correspondence to Professor Rick Iedema, Centre for Health Communication, University of Technology, Sydney PO Box 123, Broadway NSW 2007, Sydney, New South Wales, Australia; r.iedema{at}


Objective To understand what patients and family members know about problems and failures in healthcare.

Design Qualitative, semistructured open-ended interviews were conducted with 39 patients and 80 family members about their experiences of incidents in tertiary healthcare. Nineteen interviews involved more than one respondent, yielding 100 interviews in total. Participants were recruited through advertisements in the national broadsheet and tabloid print media (43%), with the help of the health services where the incidents occurred (28%), through invitations sent out by two internet marketing companies (27%) and by consumer organisations (2%).

Setting Interviews were conducted in the homes of the respondents or over the phone. One participant emailed her responses to the questionnaire.

Results Analysis of the interview data revealed: (1) considerable knowledge on the part of patients and relatives about health service risks, problems and incidents; (2) the insight of interviewees into care improvement opportunities; and (3) challenges faced by patients and relatives when trying to negotiate their knowledge and insights with health service staff.

Conclusion Patients (and family members) need access to structured processes ensuring dialogue with health service personnel about perceived risks, problems and incidents. Such dialogue would reveal patients' and family members' questions and knowledge about improvement opportunities, and minimise the risk that their questions and knowledge are ignored.

  • Health service incident
  • incident management
  • practice improvement
  • patient involvement
  • incident disclosure
  • communication
  • health policy
  • never events
  • near miss
  • patient safety
  • qualitative research
  • teamwork
  • patient-centred
  • patient satisfaction

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  • Funding This work was supported by the Australian Commission on Safety and Quality in Health Care, and we thank them for their financial and practical support and moral encouragement during the two and a half years of the project.

  • Competing interests None.

  • Ethics approval UTS HREC, approval code: 2008/300.

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