Patients and families as a source of resilience for managing hospital safety

Dr Tom Reader, Associate Professor, London School of Economics discusses the notion that the safety of organisations can be determined by the behaviours of public stakeholders (ie, non-employees).


Approximately 10% of hospital patients experience unintended harm during clinical treatments (e.g., from wrong medications), with 14% of ‘adverse events’ leading to disability or death. To improve hospital safety, psychologists have emulated the organisational safety literature by establishing the clinician behaviours (eg, teamwork, compliance) important for ensuring error-free treatments. Yet, because the target of healthcare safety work – patients – experience the harm of adverse events and participate in treatments, it is suggested that they may also have a role in improving safety. This idea is significant for the management literature because it implies that, alongside employees, the safety of organizations can be determined by the behaviours of public stakeholders (ie, non-employees).

We investigated this idea by analysing narrative accounts of unsafe care reported in over 2000 healthcare complaints (> 2 million words) submitted by patients and families to 59 UK NHS hospitals. First, patient and family reports of unsafe care were reliably associated with hospital mortality rates, showing them to be a valid source of safety information. Second, where patients and healthcare staff both reported on medical errors, patients reported important details missed by staff (eg, communication problems), indicating that they can improve understandings of why medical errors occur. Third, within the complaints, patients and families often reported engaging in behaviours (eg, voicing concerns over error, changing medications) to ensure that unrecognised or ignored safety problems were addressed, suggesting that patients are ‘active’ in supporting hospitals to manage safety. Based on the study findings, we conclude that patients and families are an important source of resilience for managing hospital safety, with them acting as a form of ‘backstop’ to catch and resolve hazards missed by employees. Therefore, and to fully explain the delivery of safe treatments, conceptual models of hospital safety should incorporate the safety behaviours of patients and families.  

About the speaker: 

Dr Tom Reader is an Associate Professor of Organisational Psychology at the London School of Economics. He directs an MSc in Organisational and Social Psychology, and is a chartered psychologist. Tom’s area of expertise is organisational safety: he investigates and develops interventions to address the cultural norms and practices important for averting accidents in teams and organisations (eg, aviation, healthcare, energy). His most recent work explores how organisations can better detect, understand, and respond to information about safety risks communicated by those without institutional power (eg, healthcare patients, junior staff). Tom consults, speaks, and advises widely on safety culture, and his research has been extensively published (Eg, Journal of Applied PsychologyJournal of Business EthicsEuropean Journal of Work and Organizational PsychologyRisk AnalysisHuman RelationsHuman Factors). 

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