Elsevier

Health Policy

Volume 90, Issue 1, April 2009, Pages 1-7
Health Policy

Review
Engaging patients as safety partners: Some considerations for ensuring a culturally and linguistically appropriate approach

https://doi.org/10.1016/j.healthpol.2008.08.007Get rights and content

Abstract

Engaging patients as ‘safety partners’ with health service providers to help identify and rectify preventable adverse events in health care is being increasingly accepted in the USA, Australia, and elsewhere as a promising strategy to improve patient safety outcomes. The implications of this trend for patients and families of minority cultural and language backgrounds have not, however, been comprehensively considered. In this article, attention is given to briefly exploring the notion of patient participation in health care and the problematic transposition of the concept into patient safety discourse. The importance of recognising and responding to the critical relationship between culture, language and patient safety outcomes, and the possible benefits and risks of engaging patients of minority ethnic backgrounds in safety partnership programs are explored. It is suggested that if patient safety engagement/partnership programs are to perform well in cross-cultural health care contexts, they need to be supported by research evidence and appropriately informed by the perspectives and experiences of patients and families/nominated carers from minority cultural and language backgrounds. They also need to be appropriately supported by culturally competent policies and practices across the entire health care system. The importance of robust internationally comparative research on this issue is highlighted.

Introduction

There is an emerging body of opinion in the international literature that patients and their families/nominated carers have an important role to play in monitoring and improving patient safety in health care settings [1], [2], [3], [4], [5], [6], [7]. Underpinning this view is a growing appreciation of the unique relationship that exists between patients and their families, and their collective capacity to provide continuous vigilance over both the patient’s health condition and the care that is given [1], [3], [8]. It is also being increasingly recognised that, unlike others who come and go, patients and their families are often situated as ‘privileged witnesses of events … who observe almost the whole process of care’ ([2], p. 99). As well as this, during the trajectory of their health care experience, patients often become ‘experts’ in their own illnesses and care and, as has been shown, can become very adept at recognising and rescuing errors (e.g. wrong drug administration), near misses (e.g. tests performed on the wrong patient) and adverse events (e.g. unanticipated adverse reactions to medications; post-surgical complications) that may not otherwise be captured by a hospital’s incident reporting system or patient case notes [2], [4], [6]. This has led some commentators to suggest that many patients and families are well positioned (during and shortly after a hospital stay) to be a ‘potentially useful source of information that could inform clinical care and guide improvement initiatives’ ([6], p. 835).

Disparities in the safety and quality care of people from minority cultural and language backgrounds are being increasingly recognised at an international level [9], [10], [11], [12], [13]. Nonetheless, and despite the growing interest in patient participation in improving health care safety, there has been a conspicuous absence of attention given to the implications of patient safety partnership initiatives for patients and families/nominated carers of minority cultural and language backgrounds, especially those who do not speak a resident country’s ‘official’ language—either proficiently, or at all. Although some reference has been made to ethnicity, language barriers, and health literacy as possible variables influencing patient participation and engagement in hospital safety processes and related outcomes (see [1], [3], [6], [14], [15], [16]), the influence of culture and language per se on patient involvement/engagement has not been comprehensively explored [17]. This is so even in contexts (e.g. the USA) where accredited health services have been formally advised to ‘consider cultural, linguistic, educational, and literacy implications of patient engagement’ [18 (p. 11)]. A key aim of this paper is to contribute to the positive project of redressing this oversight.

Section snippets

A brief overview of patient engagement in health care safety initiatives

Historically, and even since the inception of the modern patient safety movement in the late 1990s, there has been curiously little attention paid to the knowledge and experience of patients and their families on patient safety, and the role they could play in helping to reduce the incidence and impact of preventable adverse events in health care. In recent years, however, it has been increasingly contended that if patients and their families were ‘actively engaged’ by health care providers as

Concerns and controversies about engaging patients as safety partners

The notions ‘expert patient’ and ‘patients as safety partners’ as currently being used in patient safety engagement discourse are not without controversy. At the centre of these controversies are: (1) a lack of conceptual clarity and agreed definition of what the term ‘patient participation’ means, and what criteria patients need to meet in order to qualify as ‘experts’ in their own illnesses and care; (2) differences in attitudes towards engaging patients as safety partners; (3) a lack of

Culture, language and patient safety

It is being increasingly recognised that a patient’s culture and language are significant predictors of the quality of care delivered, with emerging research strongly suggesting that patients of minority cultural and language backgrounds tend to receive poorer quality of care than do majority patients [9], [10], [16]. Less well recognised, however, has been the influence that cultural and language variables (especially provider-patient cultural and language incongruence) may have on the

Concluding remarks

Developing patient safety engagement/partnership programs that will perform well in cross-cultural health care contexts pose some formidable challenges, and there is still along way to go. If patients and families/nominated carers of minority cultural and language backgrounds are to be meaningfully engaged as safety partners to improve hospital safety, it is imperative that patient safety engagement programs are appropriately informed by the perspectives and experiences of ethnic minority

References (33)

  • C.A. Vincent et al.

    Patient safety: what about the patient?

    British Medical Journal

    (2002)
  • S.N. Weingart et al.

    What can hospitalized patients tell us about adverse events? Learning from patient reported incidents

    Journal of General Internal Medicine

    (2005)
  • World Health Organisation. Patients for patient safety—statement of case, 2007,...
  • V. Entwistle

    Nursing shortages and patient safety problems in hospital care: is clinical monitoring by families part of the solution?

    Health Expectations

    (2004)
  • B.D. Smedley et al.

    Unequal treatment: confronting racial and ethnic disparities in health care

    (2003)
  • A. Bischoff

    Caring for migrant and minority patients in European hospitals: a review of effective interventions

    (2003)
  • Cited by (50)

    • The willingness and its influencing factors on patients to participate in patient safety spontaneous reports: A cross-sectional online study in China

      2021, Health Policy and Technology
      Citation Excerpt :

      Meanwhile, the willingness to participate is also influenced by perspectives and comments on patients’ participation. The importance of patients’ participation has not been well recognized by patients due to their limited understanding of PFPS [26,27]; even medical staffs hold skeptical attitudes towards patients’ participation. Many activities in this field are in progress, such as Patient Safety Awareness Week, an annual event promoted by the Patient Safety Movement Foundation (PSMF) since 2002, which intends to encourage the public to learn more about healthcare safety [28].

    • Online resources and apps to aid self-diagnosis and help seeking in the perinatal period: A descriptive survey of women's experiences

      2020, Midwifery
      Citation Excerpt :

      We note the lack of uptake of translational materials, and variable availability of bilingual research staff may have influenced our recruitment of women with limited understanding of spoken and written English. Our study suggests that to ensure inclusivity, considerable resources are needed in advocacy and outreach support to extend recruitment beyond those from majority cultural and language backgrounds (Johnstone and Kanitsaki, 2009). Our findings extend understandings from simple binaries of digital access/no-access or use/no-use to understand the range and type of use (O'Neill, 2017).

    View all citing articles on Scopus
    View full text