Perceptions of Patient Safety: What Influences Patient and Provider Involvement?

Abstract

Patient safety strategies have traditionally involved the promotion of provider-oriented practices aimed at reducing known risks associated with surgery, infection, and continuity of care. With the knowledge that patient safety incidents can significantly impact patients, providers, and health care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research. The primary objective of this research was to determine the relationship between perceptions of patient safety and the likelihood of patient involvement in both factual and challenging patient safety practices. This mixed methods study was conducted at two tertiary hospital sites located in Atlantic Canada between February 2011 and January 2012. The study design was the sequential explanatory model of mixed methods design, integrating both quantitative survey methods and qualitative focus group methods for both patient and provider participants. Survey data were analyzed using descriptive statistics and partial least squares (PLS) analysis. Focus group sessions were transcribed and analyzed using thematic analysis. The development and analysis of this research was guided by the Health Belief Model. Overall, patients were more willing to engage in factual patient safety practices (e.g., asking questions of their doctors) than challenging patient safety practices (e.g., asking a provider if they have washed their hands). The patient PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46% and 42% of the variance, respectively. The provider PLS model found that perceptions of safety culture accounted for 34% of the variance in perceptions of threat and 42% of the variance in perceptions of barriers versus benefits. Thematic analysis resulted in the identification of four major themes for both patient and providers related to the phenomenon of patient involvement. Quantitative and qualitative results were complementary in nature. Perceptions of patient safety were shown to influence both patient and provider likelihood in engaging in selected patient safety practices. Greater understanding of the roles that perceptions play in patient involvement in their care may help to improve the safety and quality of care delivered.