Patients will be asked to spot risks, report errors, and help design safety training in four new NHS safety programmes. Around 10% of hospital admissions in the NHS involve an incident that harms a patient, costing over £2 billion annually. Current safety strategies focus on changing professional behaviour and hospital systems, but there is little evidence on how best to involve patients themselves. This programme aims to fill that gap by developing and testing four approaches: a patient-completed measure of organisational safety, a patient-based error reporting system, a direct engagement intervention for medication errors, infection control, and clinical deterioration, and a patient-centred training programme for junior doctors. If successful, the research could give NHS trusts practical, evidence-based tools to reduce preventable harm—not by replacing professional vigilance, but by systematically adding the patient’s perspective to existing safety systems. The work is applied and intervention-focused; it does not explore fundamental mechanisms of error, but rather tests whether specific patient-involvement strategies are feasible, acceptable, and effective in real hospital settings.
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Aims:This programme will design, develop and evaluate four innovative approaches to engage patients in preventing patient safety incidents (PSI):1. Assessing risk 2. Reporting incidents3. Direct engagement in preventing errors4. Education and trainingBackground: Estimates suggest that in NHS hospitals, incidents causing harm to patients occur in 10% of admissions with costs to the NHS of over £2 billion. Strategies to reduce PSI have focused on changing systems of care and professional behaviour. More recently, there has been an international drive to involve patients in safety initiatives, despite little evidence on how best to achieve this. Recent reviews of the literature have highlighted: a lack of initiatives to promote patient/carer involvement in patient safety; major gaps in our knowledge about the nature and effects of patient involvement; little evidence of the feasibility or effectiveness of patient centered interventions; and uncertainty over their acceptability Research Plans1. Assessing risk: Patient measure of organisational safety: Organisational failures are easier to diagnose and manage pro-actively than individual errors. Measurement tools (eg Shell’s TRIPOD) have been developed in high-risk industries to monitor organisational safety and the applicants have developed a pro-active error management tool for health care. However these tools include little or no consideration of user’s views. This project will develop and validate a patient-completed measure of organisational safety. Phase 1: Qualitative methods to develop the measure and testing of validity and reliability. Phase 2: After a pilot study at one Trust to integrate the measure into clinical governance systems we will undertake a larger study adopting a stepped wedge design to evaluate the use of the measure to promote organisational learning in 5 NHS trusts. Qualitative and quantitative outcomes will be assessed.2. Reporting incidents: Patient-based error reporting system: Patients are ideally placed to report errors in their care yet are rarely involved in reporting or learning systems. This project will build on our expertise in error reporting and patient involvement in safety to develop and evaluate a patient-based reporting and learning system.Phase 1: An initial exploration of attitudes and methods for involving patients in reporting of errors will be undertaken using interviews and focus groups with patients and professionals. We will evaluate the volume and quality of reports from 3 different reporting mechanisms in 3 clinical settings and compare with the prevalence of PSI from case note review and routine reporting. Phase 2: Piloting and evaluation: As project 1. 3. Direct engagement: Promoting patient involvement in improving safety: We will use the MRC framework for complex interventions to develop, test and undertake an exploratory trial of a patient-centred intervention targeted at improving safety in three priority health areas: medication errors, infection control and clinical deterioration.Phase 1: Evidence collation: updating systematic reviews and qualitative research to obtain the views, perspectives and experiences of patients and professionals and inform the development of a draft intervention. Phase 2: iterative development and refinement. Testing and refining the intervention in an iterative process with patients and staff. Phase 3: An exploratory trial in 2 hospital sites leading to a tested and refined patient-centred safety intervention and a definitive RCT protocol.4. Education and training: A patient-centred training programme to improve patient safety: Early development and field testing of an innovative patient-centred training programme to improve safety using the feedback of patient experiences of error is being completed and we will evaluate the programme using a randomised cluster trial. Foundation Year doctors based in two schools will receive either no intervention or a training programme based on pat
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