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Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes
  1. Rebecca Lawton1,2,
  2. Jane Kathryn O'Hara2,
  3. Laura Sheard2,
  4. Caroline Reynolds2,
  5. Kim Cocks3,
  6. Gerry Armitage4,
  7. John Wright5
  1. 1Institute of Psychological Sciences, University of Leeds, Leeds, UK
  2. 2Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
  3. 3Department of Health Sciences, York Trials Unit, York, UK
  4. 4School of Health, University of Bradford, Bradford, UK
  5. 5Department of Epidemiology and Public Health, Royal Infirmary Bradford, Bradford, UK
  1. Correspondence to Dr Rebecca Lawton, Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK; r.j.lawton{at}


Background Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes.

Method Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for ‘harm-free care’ on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (ie, no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes.

Results The friends and family test, a single item measure of patient experience was associated with patients’ perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r2=0.39) and patient perceptions (adjusted r2=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r2=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also possible to identify differences between the acute Hospital Trusts.

Discussion The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare.

Trial registration number ISRCTN07689702.

  • Patient safety
  • Health services research
  • Surveys
  • Safety culture
  • Patient-centred care

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