Article Text

Download PDFPDF

Original research
Patient feedback for safety improvement in primary care: results from a feasibility study
  1. Andrea L Hernan1,
  2. Sally J Giles2,
  3. Hannah Beks1,
  4. Kevin McNamara1,
  5. Kate Kloot3,
  6. Marley J Binder1,
  7. Vincent Versace1
  1. 1Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
  2. 2NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
  3. 3Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
  1. Correspondence to Dr Andrea L Hernan; andrea.hernan{at}


Objectives Patient involvement in safety improvement is a developing area of research. The aim of this study was to investigate the feasibility of a patient feedback on safety intervention in primary care. Specifically, the intervention acceptability, fidelity, implementation enablers and barriers, scalability, and process of systematically collecting safety data were examined.

Design, setting and participants Mixed-methods feasibility trial with six purposively selected Australian primary care practices.

Intervention The intervention comprised an iterative process with a cycle of measurement, learning, feedback, action planning and implementation period of 6 months.

Primary and secondary outcomes Qualitative and quantitative data relating to feasibility measures (acceptability, fidelity, enablers, barriers, scalability and process of collecting safety data) were collected and analysed.

Results A total of n=1750 patients provided feedback on safety. There was a statistically significant increase in mean patient safety scores indicating improved safety (4.30–4.37, p=0.002). Staff deemed the intervention acceptable, with minor recommendations for improvement. Intervention fidelity was high and implementation enablers were attributed to the intervention structure and framework, use of intuitive problem-solving approaches, and multidisciplinary team involvement. Practice-based safety interventions resulted in sustainable and measurable changes to systems for safety, such as increased access to care and improved patient information accuracy.

Conclusions The findings indicate that this innovative patient feedback on safety intervention is feasible for scale-up to a larger effectiveness trial and further spread into policy and practice. This intervention complements existing safety improvement strategies and activities, and integrates into current patient feedback service requirements for Australian primary care. Further research is needed to examine the intervention effects on safety incident reduction.

  • quality in health care
  • primary care
  • qualitative research
  • health services administration & management

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @andreahernan11

  • Contributors ALH conceived and designed the study, and was principal investigator for the study. SJG, KM, KK and VV contributed to the study design. ALH, SJG and HB were responsible for the qualitative data analysis and manuscript preparation. VV was responsible for the quantitative data analysis and manuscript preparation. ALH created the first draft of the manuscript and was responsible for its revisions. SJG, HB, KM, KK, MJB and VV contributed to specific sections of the manuscript. All authors read and approved the final version of the manuscript.

  • Funding This work was supported by the Western Alliance Academic Health Science Centre (grant number WA-733721).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from Deakin University Human Ethics Advisory Group, Faculty of Health. Project number: HEAG-H 175_2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data are available on request to the authors.