Improving safety and quality in PHC- Safety Study


The importance of patient safety and quality research is renowned worldwide, but research outlining the interventions, intended outcomes, measurement and effectiveness are few and far between. Most of the research surrounding patient safety has focused on measurement and identifying what constitutes a risk, analysing, evaluating and managing risks effectively. Identifying practices and process of successful quality improvement can lead to effective results through greater understanding of the development, design and evaluation of complex interventions. Davidoff & Batalden (2005) point out that health care safety and quality research adds to scientific discovery and experiential learning, and that disseminating knowledge leads to better performance.However, there is still lack of relevant, timely, appropriate, accurate and transparent studies on this topic.

Research on safety in primary care is just beginning to emerge as much of the literature has focussed on secondary care settings. Furthermore, research involving patients and carers is in its infancy and there has been a call to engage and partner with patients more effectively to improve the safety and quality of care they receive.

Patients and carers have an important role to play when preventing errors and reducing harm. They have firsthand experience of their care, and are often able to provide detailed information about the processes, systems and structures that have led to the occurrence of an adverse event. Although there are many well-recognised benefits for involving patients to improve the safety of their care, there are still some unresolved contentions regarding the effectiveness of interventions, the roles and responsibilities for both patients and health professionals, and the kind of health care culture and organisational governance required for patient involvement in safety to occur successfully.

A systematic review of the effectiveness of interventions designed to improve the delivery of patient centred care has shown that there are some promising approaches. This mainly includes improving patient education, health literacy, self-management skills, and capacity for making decisions, as well as developing partnerships with physicians, and contributing to safety and quality of care. There is also a growing evidence base centred on how health professionals can better support patient engagement in care. Patient involvement in health care has been proposed as a promising approach to achieving better quality of care, greater cost efficiency, and improved population health.

Much of the literature on patient involvement in safety has focussed on partnering with patients to reduce harm in hospital settings. Hand hygiene interventions and speaking up campaigns dominate the evidence base in this area. However, research that has been conducted in general practice is scarce. A tool to measure patient involvement in decision making in general practice has been developed by Elwyn and collegues (2003), Sanders et al (2013) have found that interventions aiming to increase patient participation as a means to improve health outcomes in general practice are non-conclusive, and Flink et al (2012) have investigated patient activation during handover between primary and secondary care. Apart from these studies little else has been undertaken in this setting.

To the authors knowledge only one study conducted in Australian general practice found that patient directed questioning improved information provision by physicians and patient involvement in safety.

While there are some examples of partnering with patients to improve the safety of primary care, there is no evidence of how patients and carers view safety. Having an in depth understanding of patients and carers perceptions of safety is the starting point for designing and implementing effective and appropriate interventions that can help to reduce harm in the primary care setting.


Updated:  24 September 2017/Responsible Officer:  Director, APHCRI/Page Contact:  Web Admin, APHCRI