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Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.

Daker-White G, Hays R, McSharry J, Giles S, Cheraghi-Sohi S, Rhodes P, Sanders C - PLoS ONE (2015)

Bottom Line: Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface.The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.Electronic systems can compromise safety when they override the opportunities for face-to-face communication.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.

ABSTRACT

Objective: Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.

Method: Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.

Results: Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.

Conclusion: Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.

No MeSH data available.


Related in: MedlinePlus

Promoting Patient Safety in Primary Care.
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pone.0128329.g002: Promoting Patient Safety in Primary Care.

Mentions: Synthesizing the translations from the different subsets of studies (showed that they were principally concerned with the factors, processes or issues that either promote (Fig 2) or degrade (Fig 3) patient safety in primary care. The main issues grouped into the characteristics or behaviour of patients or staff; interaction between patients and staff or staff and other staff; and organisational or systems issues that confronted patients or staff. Many issues point to the fact that human beings do not always “fit” systems or behave or perform in ways that they are “supposed” to. The main threats seem to centre on time and resource constraints. Simply, if family practices had more staff, more resources and more time to spend with each patient, then they would be safer places for patients. Other issues point to the historic power and autonomy of doctors which again presents challenges for “standardised” systems or operating procedures.


Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.

Daker-White G, Hays R, McSharry J, Giles S, Cheraghi-Sohi S, Rhodes P, Sanders C - PLoS ONE (2015)

Promoting Patient Safety in Primary Care.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526558&req=5

pone.0128329.g002: Promoting Patient Safety in Primary Care.
Mentions: Synthesizing the translations from the different subsets of studies (showed that they were principally concerned with the factors, processes or issues that either promote (Fig 2) or degrade (Fig 3) patient safety in primary care. The main issues grouped into the characteristics or behaviour of patients or staff; interaction between patients and staff or staff and other staff; and organisational or systems issues that confronted patients or staff. Many issues point to the fact that human beings do not always “fit” systems or behave or perform in ways that they are “supposed” to. The main threats seem to centre on time and resource constraints. Simply, if family practices had more staff, more resources and more time to spend with each patient, then they would be safer places for patients. Other issues point to the historic power and autonomy of doctors which again presents challenges for “standardised” systems or operating procedures.

Bottom Line: Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface.The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.Electronic systems can compromise safety when they override the opportunities for face-to-face communication.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.

ABSTRACT

Objective: Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.

Method: Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.

Results: Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.

Conclusion: Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.

No MeSH data available.


Related in: MedlinePlus