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• The importance of patient participation
  Michael van der Voorden, Kees Ahaus and Arie Franx
  Published on: 29 March 2023
• Authentic Partnerships in Patient Safety
  Deborah L. Dokken, Beverley H. Johnson
  Published on: 15 March 2023

• Published on: 29 March 2023

  The importance of patient participation

  • Michael van der Voorden, Manager / PhD candidate Erasmus University Medical Center
  • Other Contributors:
    • Kees Ahaus, Professor in Health Services Management & Organization
    • Arie Franx, Professor of Obstetrics

  Firstly, in this response to the earlier comments of Deborah L. Lokken and Beverley H. Johnson of February 24, 2023, we agree that patient participation in patient safety is of huge importance. Sorry that we may be gave you the wrong impression and we would like to apologize for this. We see it as a positive development towards a true partnership in healthcare between patient and professional, however, there can be also concerns or risks if patients participate. We therefore also need the negative effects of patient participation in patient safety to take the next step in the development of patient participation.

  To take the next step in the contribution of patients and their families to patient safety, it is important to examine the full context and see which ‘gaps’ need to be addressed. Even if focusing only on negative effects could lead to a bias, identifying these gaps will us learn which ones there are and therefore also what we need to work on in order to make that positive contribution of patients in patient safety. For that reason, we have also indicated as a recommendation from this study that it is necessary to find the measures that need to be taken to either prevent these negative effects or address them ad hoc as soon as they occur.

  We can understand that the authors have some questions about the initiatives mentioned or about the small sample size. We have included the small sample size as a limitation. However, as also described in our publi...

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  Firstly, in this response to the earlier comments of Deborah L. Lokken and Beverley H. Johnson of February 24, 2023, we agree that patient participation in patient safety is of huge importance. Sorry that we may be gave you the wrong impression and we would like to apologize for this. We see it as a positive development towards a true partnership in healthcare between patient and professional, however, there can be also concerns or risks if patients participate. We therefore also need the negative effects of patient participation in patient safety to take the next step in the development of patient participation.

  To take the next step in the contribution of patients and their families to patient safety, it is important to examine the full context and see which ‘gaps’ need to be addressed. Even if focusing only on negative effects could lead to a bias, identifying these gaps will us learn which ones there are and therefore also what we need to work on in order to make that positive contribution of patients in patient safety. For that reason, we have also indicated as a recommendation from this study that it is necessary to find the measures that need to be taken to either prevent these negative effects or address them ad hoc as soon as they occur.

  We can understand that the authors have some questions about the initiatives mentioned or about the small sample size. We have included the small sample size as a limitation. However, as also described in our published article, we only reached these conclusion by reaching saturation. The examples of initiatives cited in the research such as the participation in medication safety that you are refer to, are not new initiatives but rather demonstrated initiatives of patient participation in patient safety within an Obstetrics department. In this study, it was decided to offer a new insight based on the respondents from the professional- and patient side. We recognize that in the future it may be interesting to also include the families of pregnant woman in the study, to see and investigate what findings emerge.

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  Conflict of Interest:
  None declared.

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• Published on: 15 March 2023

  Authentic Partnerships in Patient Safety

  • Deborah L. Dokken, Senior Specialist, Patient and Family Partnerships Institute for Patient- and Family-Centered Care
  • Other Contributors:
    • Beverley H. Johnson, President and CEO

  For more than 30 years, our organization, the Institute for Patient- and Family-Centered Care (IPFCC) has been a leader in helping other organizations develop and sustain effective partnerships with patients and families to improve the quality, safety, and the experience of care. During that same time, the patient safety movement has affirmed the important roles of patients and their families in safety.

  We are concerned about the recent BMJ Open article, “Explaining the negative effects of patient participation in patient safety,” and the very different message it conveys. Our concerns center on the authors’ misunderstanding of what true partnership means in health care and the inherent bias in the structure of the research. Additionally, there was no patient or partner involvement in the “design, conducting, reporting, or dissemination plans of the research.”

  The questions in the “topic guide” were leading and reflected bias; therefore, they could only elicit negative views from respondents. The sample size of 8 professionals and 8 patients is small in establishing such strong conclusions.

  A patient in labor having the responsibility for checking the accuracy of medications was not an appropriate example of patient participation in safety nor of an understanding of partnership. Authentic partnership would entail a discussion about patient safety as a team responsibility and a determination from the patient on how she wishes to participate on that...

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  For more than 30 years, our organization, the Institute for Patient- and Family-Centered Care (IPFCC) has been a leader in helping other organizations develop and sustain effective partnerships with patients and families to improve the quality, safety, and the experience of care. During that same time, the patient safety movement has affirmed the important roles of patients and their families in safety.

  We are concerned about the recent BMJ Open article, “Explaining the negative effects of patient participation in patient safety,” and the very different message it conveys. Our concerns center on the authors’ misunderstanding of what true partnership means in health care and the inherent bias in the structure of the research. Additionally, there was no patient or partner involvement in the “design, conducting, reporting, or dissemination plans of the research.”

  The questions in the “topic guide” were leading and reflected bias; therefore, they could only elicit negative views from respondents. The sample size of 8 professionals and 8 patients is small in establishing such strong conclusions.

  A patient in labor having the responsibility for checking the accuracy of medications was not an appropriate example of patient participation in safety nor of an understanding of partnership. Authentic partnership would entail a discussion about patient safety as a team responsibility and a determination from the patient on how she wishes to participate on that team. Further, the article made no mention of care partners/family members and their important, additional, role in patient safety.

  Over the years, the BMJ has published many articles that have furthered the understanding of and commitment to sound patient safety practices and partnerships with patients and families. Many readers remember the 9/18/99 theme issue, “Embracing Patient Partnership,” and its dramatic cover of the tango dancers. Unfortunately, this current article seems like an anomaly.

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  Conflict of Interest:
  None declared.

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