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How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory
  1. Emily Barrow1,
  2. Rachael A Lear1,2,3,
  3. Abigail Morbi2,
  4. Susannah Long1,3,
  5. Ara Darzi1,2,
  6. Erik Mayer1,2,3,
  7. Stephanie Archer1,2,4,5
  1. 1NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
  2. 2Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3Imperial College Healthcare NHS Trust, London, UK
  4. 4Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  5. 5Department of Psychology, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Stephanie Archer, NIHR Imperial Patient Safety Research Centre, Institute of Global Health Innovation, Imperial College London, London W2 1PG, UK; stephanie.archer{at}imperial.ac.uk

Abstract

Background Efforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives.

Methods A qualitative semi-structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo-writing using the clustering technique were used to develop a model of how patients conceptualise patient safety.

Results While some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them ‘feel safe’. Patients’ feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care.

Conclusions Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice.

  • Patient safety
  • Hospital medicine
  • Qualitative research
  • Health services research

Data availability statement

No data are available. The qualitative data used in this study are not available as these were not included in our study ethics and we did not seek consent for these.

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Data availability statement

No data are available. The qualitative data used in this study are not available as these were not included in our study ethics and we did not seek consent for these.

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Footnotes

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  • EB and RAL contributed equally.

  • Contributors EB and RAL contributed equally to this paper. EB, SA, SL and EM designed the study. EB conducted the interviews. Coding of data was conducted by EB and AM, and supervised by SA and SL. RAL contributed to the grounded theory and drafted the manuscript. All authors contributed to the revision, editing and approval of the final version of the manuscript. SA is the guarantor.

  • Funding This study was funded by the Patient Safety Translational Research Centre (PSTRC-2016-004) and NIHR Imperial Biomedical Research Centre (IS-BRC-1215-20013). The research was enabled by the iCARE environment and used the iCARE team and data resources.

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

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.