Patient safety in outpatients: Supporting patients to help keep themselves safe

Summary

This blog is part of a series in which NHS rheumatology consultants Anne Kinderlerer and Benjamin Ellis highlight some of the key patient safety risks in outpatients and look at why these issues have been neglected by health systems. 

In this blog, they look at how empowering patients to take ownership of their care improves safety. They describe the need for a culture shift away from patients as passive recipients of care and look at how this might be achieved. Through new communication approaches, actively encouraging self-advocacy and improving patients’ access to their own health records, the health system can offer more opportunities for patients to be involved in their own safety.

Content

The health system in the UK has often given the public the impression that it is solely in charge of their healthcare. This has led to a culture where patients sometimes take a passive stance towards their treatment; for example, by assuming they can wait for their results to be sent to them or not questioning when they don’t hear from their doctor.

There’s a fine balance of roles and responsibilities in healthcare. Ultimately we are responsible as healthcare professionals for the care we provide, but patients can also have a role in  making their care safer. Healthcare systems and clinical teams that support patients with this improve the chances of catching mistakes before they lead to harm.

When patients and their carers have the right knowledge, skills, support and resources to take ownership, we know it improves outcomes and reduces the risk of errors in their care. 

Simple things can make a difference. For example, by ensuring that patients understand what should happen after their appointment, they can hold us to account when the follow-up doesn’t go to plan. If a patient knows they should get their scan results within two weeks, they should be supported to know who to contact, how to contact them and what to ask for if they don’t hear anything in that timeframe. 

Barriers to patients being active in their care

It’s clear that supporting patients to take an active role in their care is an important aspect of improving patient safety in outpatients. But there are several significant issues that prevent many patients working with their healthcare team to do this.

Lack of trust between patients, doctors and healthcare teams 

The relationship between a patient and their doctor, other clinicians and the wider team is vital to patient safety. If a patient feels that the last time they asked a question they got told off, they will soon stop asking questions. This applies right the way through the system at every point where a patient interacts with a member of staff.

One example is that if a GP’s receptionist has a reputation for being rude, people may be reluctant to call to make an appointment. If we put up a high barrier to accessing care, it prevents people who really need help from seeking it. If patients are afraid to challenge doctors because of previous experiences, they will be less able to make informed decisions about their care, less able to express what matters to them and less able to flag errors when they inevitably occur. 

Healthcare professionals need to ensure they are not defensive and invite input from patients. However, many clinical teams struggle with increasingly unrealistic workloads which strains their ability to maintain openness to patient challenge. So we also need to consider the impact of workload on the clinician–patient relationship and how this in turn affects the patient’s ability to be open with their clinician. 

Perceptions that the NHS is ‘too busy’

There is currently a perception that health services are too busy to see patients and that has a direct impact on patient safety in outpatients—and more widely. Patients have told us that they haven’t gone to A&E because they thought it was pointless. If people don’t seek care because they believe there are no appointments, that they will be turned away or that they shouldn’t burden the system, we could be missing or delaying significant diagnoses.

Health inequalities and health literacy

We need to recognise that the safety risks are even higher for patients who are less able to advocate for themselves. This may be because of cultural and language differences, low health literacy, disability and many other factors. We need to find ways of identifying people who are already underserved and supporting them to navigate the system. 

How can we empower patients to keep themselves safe?

To overcome these issues, we really need to see a culture shift in the healthcare system. This is going to involve challenging the paternalistic attitudes that are common among many doctors and in many services.  

Providing clear, understandable information

The failure to communicate key information to patients is a major issue that we must address. If people don’t understand how the system works or where to go for help, it will be much harder for them to play an active role in their care. This is particularly important for patients with long-term conditions who might be being seen in multiple specialties across different places. When people actually know what’s going on, they can highlight when the plan isn’t being followed, as well as feeling that they can approach the contacts they have been given for help.

One way we can support patients to take an active role in their care is by reassessing the way we write clinic letters. Traditionally, clinic letters are addressed to the patient’s GP, with the patient copied in. However, national guidelines suggest that we should address letters to patients, with their GP copied in. This is a great way to signal to the patient that they are the key partner in their care. It’s important that letters addressed to patients are accessible and avoid medical jargon, phrases that could be perceived as aggressive and acronyms. Benjamin has seen how this can improve safety as he has had patients call up and correct mistakes in letters which might otherwise have been missed. Giving patients ownership of their detailed medical information positions them as collaborators rather than recipients of care.

Promoting patient access to health records

As mentioned above, when patients have easy access to their health records, they are able to help ensure the safety of their care. Although there are risks associated with patient access, tools such as the NHS App have huge potential to improve patient safety in outpatients.

Training staff to communicate non-defensively

We need to ensure that every member of staff interacting with patients is trained to understand the impact their communication can have on patient safety.

Further blogs in the outpatient series:

• Patient safety in outpatients: What are the risks and why aren’t we dealing with them?
• Patient safety in outpatients: What are the gaps in measuring and reporting harm?

Related reading on the hub:

• The challenges of navigating the healthcare system: Sue's story
• Lost in the system? NHS referrals

Get involved

If you work in outpatients, or are a patient with experience of outpatients and ideas about how to improve safety, we’d love you to join the conversation. You can:

• comment on this blog (you will need to sign up for free to join the hub first).
• share your experience as a patient, relative, carer or member of staff in our community conversation.