Seeing It from Both Sides: Do Approaches to Involving Patients in Improving Their Safety Risk Damaging the Trust between Patients and Healthcare Professionals? An Interview Study

ObjectiveEncouraging patients to be more vigilant about their care challenges the traditional dynamics of patient-healthcare professional interactions. This study aimed to explore, from the perspectives of both patients and frontline healthcare staff, the potential consequences of patient-mediated intervention as a way of pushing safety improvement through the involvement of patients. DesignQualitative study, using purposive sampling and semi-structured interviews with patients, their relatives and healthcare professionals. Emergent themes were identified using grounded theory, with data coded using NVIVO 8. Participants16 patients, 4 relatives, (mean age (sd) 60 years (15); 12 female, 8 male) and 39 healthcare professionals, (9 pharmacists, 11 doctors, 12 nurses, 7 health care assistants). SettingParticipants were sampled from general medical and surgical wards, taking acute and elective admissions, in two hospitals in north east England. ResultsPositive consequences were identified but some actions encouraged by current patient-mediated approaches elicited feelings of suspicion and mistrust. For example, patients felt speaking up might appear rude or disrespectful, were concerned about upsetting staff and worried that their care might be compromised. Staff, whilst apparently welcoming patient questions, appeared uncertain about patients’ motives for questioning and believed that patients who asked many questions and/or who wrote things down were preparing to complain. Behavioural implications were identified that could serve to exacerbate patient safety problems (e.g. staff avoiding contact with inquisitive patients or relatives; patients avoiding contact with unreceptive staff). ConclusionsApproaches that aim to push improvement in patient safety through the involvement of patients could engender mistrust and create negative tensions in the patient-provider relationship. A more collaborative approach, that encourages patients and healthcare staff to work together, is needed. Future initiatives should aim to shift the current focus away from “checking up” on individual healthcare professionals to one that engages both parties in the common goal of enhancing safety.研究目的 促使患者更加警惕自身的照护挑战，这一理念对传统的医患互动模式构成了挑战。本研究旨在从患者与一线医护人员双视角出发，探究以患者为中介的干预手段——即通过患者参与推动患者安全改进——可能产生的潜在影响。研究设计 本研究为质性研究，采用目的性抽样方法，对患者、家属及医护人员开展半结构化访谈。采用扎根理论识别核心主题，并通过NVIVO 8软件对数据进行编码。研究对象 共纳入16名患者、4名家属（平均年龄60岁，标准差15岁；女性12名，男性8名）以及39名医护人员，其中包括9名药剂师、11名医生、12名护士及7名医疗辅助人员。研究场景 研究对象招募自英格兰东北部两家医院的普通内科与外科病房，涵盖急诊及择期收治的患者。研究结果 本研究发现了该模式的积极影响，但当前以患者为中介的干预手段所鼓励的部分行为，却引发了怀疑与不信任情绪。例如，患者认为主动发声可能显得粗鲁无礼，担心会冒犯医护人员，同时担忧自身的照护质量会受到影响。医护人员表面上欢迎患者的提问，但对患者提问的动机存疑，并认为那些频繁提问或记录内容的患者是在准备投诉。此外，本研究还识别出可能加剧患者安全问题的行为后果：例如医护人员会刻意回避与爱提问的患者或家属接触，而患者则会避开态度不友善的医护人员。研究结论 旨在通过患者参与推动患者安全改进的相关举措，可能会引发不信任情绪，并在医患关系中制造负面张力。当前亟需一种更具协作性的模式，鼓励患者与医护人员携手合作。未来的相关计划应将重心从“监督”个体医护人员，转向促使双方共同为提升安全这一共同目标而努力。