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