Healthcare research increasingly observes that patients and families can be highly active in trying to prevent medical accidents. However, the safety literature lacks a model of these behaviors. Addressing this gap would not only advance understanding on how patients and families contribute to healthcare safety, but also provide a general framework for studying how non-employee stakeholders such as citizens and service-users influence safety outcomes in other organizational contexts. Therefore, the current study aimed to establish a model of the behaviors used by patients and families to prevent accidents and ensure safety whilst in hospital. Using a mixed qualitative-quantitative research design, we analyzed 1,857 healthcare complaints submitted by patients and families to UK hospitals reporting poor treatment experiences. Our analysis focused upon reports within the complaints of healthcare users engaging in (1) voicing behaviors to raise concerns about safety with staff and (2) correcting behaviors to directly resolve safety issues. Approximately three quarters of complaints reported patients and families having engaged in voicing and correcting behaviors, with them often doing so to ensure the resolution of missed and emerging safety problems. The behaviors contributed to hospital safety outcomes through helping staff to spot and resolve errors and hazards, intervening to ensure that safety standards were maintained, and bypassing teams and hospitals when they were judged as too unsafe. The study adds to the literature by establishing a framework for studying how the behaviors of non-employee stakeholders in healthcare and other domains contribute to organisational safety.
- Les auteurs se penchent sur les outils dont disposent les patients et leur famille pour intervenir dans le processus de soins : exprimer leur opinion, leurs doutes ou leur désaccord (« voicing »), et mener des actions correctrices (refuser un traitement inadapté, prendre des initiatives de surveillance ou de monitorage si le personnel est absent, etc.). Les auteurs analysent 1857 plaintes intelligibles reçues par le NHS entre 2013 et 2014, échantillonnées au premier et troisième quadrimestre pour éviter un biais de saisonnalité. Ces rapports sont analysés par des psychologues experts en gestion de la sécurité, à la recherche en particulier des initiatives d’avertissement et de correction en rapport avec la sécurité des patients. La moitié de ces initiatives (43%) modifient le cours des événements, en pointant des initiatives qui n’ont pas été prises, ou qui l’ont été erronément. La réponse des soignants est coopérative dans la moitié des cas, mais est hostile dans 30%. Le mode d’intervention des patients peut être coopératif (aider), interventionnel (intervenir), ou de contournement (appel à un intervenant tiers). Cette étude s’est déroulée avant la pandémie de Covid-19, et la prise de conscience, maintenant universelle, de l’importance de la participation du patient et de ses proches à la gestion de sa sécurité.
Reader TW, Gillespie A.
The active patient: Voicing and correcting behaviors by patients and families to ensure safety in healthcare organizations. Saf Sci. 2026;193:107026. Doi : 10.1016/j.ssci.2025.107026.