Safety Through the Patient's Eyes
In this chapter we have conceptualised safety in the context of a patient's healthcare journey showing good quality care but also encompassing a number of types of serious failure and harm. The implications of this way of approaching safety will be explored in detail in the second section of the book but it will be useful to indicate some general directions here.
The Patient Potentially Has the Most Complete Picture
The most obvious point to emerge from studying treatment over time is that the patient is, even more than in hospital, a privileged witness of events. Patient reported outcome measures are of course already a high priority, but we clearly need to begin to find ways of tracking patient experience of healthcare over time and integrating this information with available clinical information. This is easy to say but likely to be a task of considerable difficulty.
The Healthcare professional's View Is Necessarily Incomplete
Each healthcare professional involved with a patient will only have a partial view of the patient journey. Even within hospital, whether notes are electronic or paper, it can be difficult to understand the trajectory of patient care. The problem is even more acute outside hospital. A good general practitioner or family doctor is best positioned to understand the full patient journey, but we will need to develop methods of representing the full perspective of care that can be shared across different settings.
The Resources of the Patient and Family Are Critical to Safe Care
Increasingly patients and families are managing the complex work of coordinating their care. The formal assessment of these resources, financial, emotional and practical will become essential to the coordination of care and the idea of the patient as part of the healthcare team will move from being an aspiration to a necessity. This can certainly bring benefits in terms of patient engagement and patient empowerment but also carries risks as patients shoulder the burden of organising and delivering care and the locus of medical error moves from professionals to patients and families.
Coordination of Care Is a Major Safety Issue
Patients with multiple problems already have multiple professionals involved in their care and face major challenges in coordinating their own care. Poor communication across different settings is frequently implicated in studies of adverse events in hospital and in inquiries into major care failures in the community. Safety interventions in these settings may be less a matter of care bundles and more concerned with wider organisational interventions to ensure rapid response to crises and coordination between agencies.