Response to the report of the Patient Safety Commissioner – first 100 days
16 March 2023
Bev Fitzsimons welcomes the Patient Safety Commissioner’s focus on culture change, but for this to have real impact we need a more complete understanding of what it means to ‘listen to patients’.
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I was interested to read the report of the first 100 days in post for the new Patient Safety Commissioner, published last month by the Patients Association. It is important that the role of PSC exists, and we hope it is a catalyst for change. We welcome Dr Hughes to the post, and appreciate the transparency of a report of this kind.
With that said, I found it dispiriting to read – mainly because the diagnosis seems unchanged since 2020, when First Do No Harm was published. The same key issues are still present: patients are feeling that they aren’t listened to, are fobbed off or not taken seriously.
Yet again we hear that “we need a seismic shift in the way that patients’ and families’ voices are heard.” Our health system spends too much time looking backwards at what has gone wrong. We need to stop harm in advance, understanding its predictors. It’s the same old stable door argument.
The same key issues are still present: patients are feeling that they aren’t listened to, are fobbed off or not taken seriously.”
Back in 2018, Jocelyn Cornwell and I commented on the problem that efforts to improve quality have tended to treat dimensions of care (safe, effective, patient-centred, timely, efficient and equitable) as separate rather than interrelated. Despite calls for patients to be involved in patient safety, patients and families do not play much part in patient safety: their input in this area is seen as subjective and less relevant to outcomes. But safety is not a separate thing: it is a core part of the whole picture of people’s experience of care. It is a mistake to think of safety only in terms of errors, mistakes, misdiagnoses, failures of devices.
Patients and families are among the biggest asset available to the patient safety system. Jane O’Hara has reported on how closely matched the numbers of incidents patients and clinicians report about patient safety. But reports from patients are treated differently, with them being far less likely to be considered a patient safety incident by clinicians than reports by other professionals. So why the divergence? Digging deeper into the analysis shows that patients include a broader range of issues in their definition of a safety incident. They include things like communication, staffing, compassion, feeling afraid, dignity and respect, food and nutrition, and the ward environment. There is more than one type of safe care.
It is hard not conclude that this is an example of epistemic injustice, where the patients’ testimonies are downgraded because of who is giving them.
Our current safety systems can be likened to smoke detectors of harm already taking place, and patients’ experiences are more like a pressure gauge showing a system under pressure and likely to go wrong. So while I welcome Dr Hughes’ recommendations that patients’ voices should be heard in governance, Board meetings, and all aspects of service design, until we address the fact that patients’ voices are not truly heard, with curiosity and without defensiveness, we’ll struggle to make progress. This represents a much bigger culture change than simply hearing a patients’ story.