Article Text

Download PDFPDF

What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study
  1. Jane K O’Hara1,2,
  2. Caroline Reynolds2,
  3. Sally Moore2,
  4. Gerry Armitage3,
  5. Laura Sheard4,
  6. Claire Marsh2,
  7. Ian Watt5,
  8. John Wright6,
  9. Rebecca Lawton2,7
  1. 1 Leeds Institute of Medical Education, University of Leeds, Leeds, UK
  2. 2 Department of Quality and Safety, Bradford Institute for Health Research, Bradford, UK
  3. 3 School of Health, University of Bradford, Bradford, UK
  4. 4 Bradford Institute for Health Research, Bradford, UK
  5. 5 Department of Health Sciences, University of York, York, UK
  6. 6 Department of Epidemiology and Public Health, Royal Infirmary Bradford, Bradford, UK
  7. 7 Institute of Psychological Sciences, University of Leeds, Leeds, UK
  1. Correspondence to Dr Jane K O’Hara, Leeds Institute of Medical Education, University of Leeds, Leeds LS2 9JT, UK; jane.o%E2%80%99hara{at}


Background Patient safety measurement remains a global challenge. Patients are an important but neglected source of learning; however, little is known about what patients can add to our understanding of safety. We sought to understand the incidence and nature of patient-reported safety concerns in hospital.

Methods Feedback about the experience of safety within hospital was gathered from 2471 inpatients as part of a multicentre, waitlist cluster randomised controlled trial of an intervention, undertaken within 33 wards across three English NHS Trusts, between May 2013 and September 2014. Patient volunteers, supported by researchers, developed a classification framework of patient-reported safety concerns from a random sample of 231 reports. All reports were then classified using the patient-developed categories. Following this, all patient-reported safety concerns underwent a two-stage clinical review process for identification of patient safety incidents.

Results Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.

Conclusions Our findings suggest that patients can provide insight about safety that complements existing patient safety measurement, with a frequency of reported patient safety incidents that is similar to those obtained via case note review. However, patients provide a unique perspective about hospital safety which differs from and adds to current definitions of patient safety incidents.

Trial registration number ISRCTN07689702; pre-results.

  • adverse events, epidemiology and detection
  • human factors
  • medical error
  • measurement/epidemiology
  • patient safety
  • quality measurement

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JKO’H and GA designed the data collection tools. RL, JKO’H, GA, LS, CM, IW and JW managed the randomised controlled trial from which the data for this paper was drawn. JKO’H, RL, GA, JW, IW, CR and SM contributed to the drafting of the paper. SM and CR managed the data collection, managed the framework development exercise with patient representatives. All contributors agreed the final version of the paper.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Improving safety through the involvement of patients: grant reference number RP-PG-0108-10049).

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval for data collection was granted by the NRES Committee Yorkshire & Humber (South Yorkshire), reference 13/YH/0077.

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

  • Data sharing statement Data requests should be sent to the corresponding author regarding anonymised, aggregated data dependent on what is allowable within the data protection act. This study has formed the basis of a number of conference presentations, and results have been fed back to the NHS organisations involved. We plan to disseminate this more widely via patient advocacy groups and health service professional journals.

Linked Articles