When it comes to improving patient safety, should we be learning from the patient?

By | December 11, 2018

All of us in healthcare are striving to improve patient safety; but our current systems for tracking diagnostic errors have focused on individual clinicians’ decisions based on data and system designs and not information from the patient. Relatively few systems capture information from patients with the purpose of aiding in the understanding of such mistakes. A recent study in Health Affairs by Giardina et al., Learning from Patients’ Experiences Related to Diagnostic Errors is Essential for Progress in Patient Safety, found 184 unique patient narratives that may aid in understanding the causes of such errors.

A common thread, found in 50% of the narratives discovered to have diagnostic errors, involved the patient belief the health care provider ignored their knowledge about their own health, viewed through their lens, and pertinent information they deemed would be useful to their providers. These included worrisome symptoms, changes in their health status or their failure to improve.

Also discovered, was the pervasive impression of disrespect felt by the patient and their families from their provider. These narratives highlighted belittlement or mocking and rude behavior by clinical staff. Furthermore, patients noted a breakdown or failure in patient-provider communication. Relating to this diagnostic error included delays in sharing test results and corresponding clinical conversations that the patients deemed were important. Finally, the last contributory narrative identified by a little less than 10% of the narratives identified perceived manipulation or deception by the provider to the patient.

To reduce patient harm, including narrative information in the attempt to understand the cause of decision errors or serious safety events is an additional source of data that may be beneficial. These findings potentially aid in identifying clinician behavior that may impact harm. Furthermore, the uncovering of a communication breakdown between patients and healthcare workers may occur.

Hence, patient-centeredness and shared decision-making requires us to not only be mindful of the needs of those we serve, but also hear their voice and incorporate it into our learnings on how to reduce harm and improve safety. Systematically collecting and coding complaint narratives where errors have occurred is one way to understand system issues about human behaviors. Tracking and compiling unsolicited narratives may reveal thematic problems before an error occurs.

Consequently, designing solutions focused on the root causes of error and harm can only occur if we have all the pertinent information at hand. Moreover, elevating the patient and family narratives as data points are essential to understanding the entire picture. We may also impart these same principles in capturing thematic problems from others involved in care in a manner that elevates the voice of all. Designing tools and codification of the information will be foundational to successful implementation.

Continually striving to learn and improve, in such modalities will only enhance our abilities to better understand the dynamics of decision errors and other causes of harm. Although it may take more time, our patients very often are the key to the bigger picture. Knowing this, we will simultaneously elevate the voice of those we serve and those that deliver care.