Constructing patient safety. Exploring unsafe care events in hospital settings as reported by patients, relatives, and healthcare professionals

Abstract

The conditions of hospital care are continuously transformed with advances in medicine and technology, and with organizational alterations influenced by the changing needs of the population. As these conditions affect patient safety, and because adverse events are a global public health problem today, knowledge about how unsafe care is understood and how patient safety can be achieved is needed. The overall aim was to explore the meaning and construction of patient safety. Three qualitative methods were used to analyze the collected data. In Studies I and II, 29 reported adverse events were analyzed using discourse analysis to explore discourses about patients and healthcare professionals. In Study III, 79 complaints were analyzed using qualitative content analysis to explore patients’ and relatives’ accounts of access. Study IV was a constructivist grounded theory study that explored how 12 individuals identified and responded to patient safety risks and adverse events. The findings in Studies I and II showed how the discourses that save lives also had the potential to cause adverse events. Study III showed how patients and relatives struggled to gain access by trying to legitimize their concerns as credible to receiving the care they needed. Study IV showed that the process of understanding patient safety risks started the moment the patients entered the hospital. Their understanding of adverse events kept evolving as long as questions remained unanswered. The lack of answers and recognition of concerns added to the suffering and, in the worst case, caused adverse events. In conclusion, when patients and relatives reached their limits in maintaining patient safety themselves, and their concerns and suffering were not acknowledged, this potentially caused adverse events and long-lasting suffering. The findings suggest that the structures of hospital care need to be evaluated regularly to ensure that they work to include the patients’ and relatives’ understandings of how patient safety can be achieved.