Healthcare professionals’ understanding of patient safety: relevance to the development of person-centered medicine

Abstract

Aims and Objectives: The success of patient safety initiatives in the development of person-centered models of clinical care depends on the engagement of ‘frontline’ clinical staff. However, little is known about how such staff understand and act on notions of risk and safety. We aimed to explore this understanding through qualitative inductive analysis of interview data from healthcare staff in an acute hospital. Method and Results: We interviewed 43 members of staff and analysed the interviews using a grounded theory approach. ‘Patient safety’ was understood within each participant’s own work context. We noted discrepancies in that understanding, with ‘vertical’ differences (variations in experience and seniority) within one professional group and ‘horizontal’ differences between groups. Risk was generally seen as intrinsic to daily working life. Participants focus on managing rather than trying to avoid risk. An informal but complex conceptualisation identified ‘professional’ and ‘situational’ risk. Participants also distinguished ‘acceptable’ from ‘unacceptable’ risk and ‘avoidable’ from ‘unavoidable’ risk. These contrasts seemed to help them decide whether it is feasible, necessary and/or beneficial to intervene when a risk appears. Further, different individuals and groups were recognized to have understanding and ‘ownership’ of specific risks or groups of risks.  Formal manifestations of safety systems, such as protocols and procedures, were recognised as useful, but concerns were expressed about the quantity and currency of protocols and about the difficulties caused by lack of resource.Conclusion: We suggest that an understanding of how health professionals deal informally with ideas about safety and risk should be used to shape and enhance formal safety initiatives in health services as an important contribution to the development of person-centered clinical care.