Yes / Evidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time. To undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. Design: A qualitative evaluation design was adopted across two acute NHS Trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n = 15), voluntary services and patient experience staff (n = 3) and semistructured interviews with ward staff (n = 5). Data were interpreted using framework analysis. Results: All stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase. Conclusion: Although there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement. / The Health Foundation (Closing the Gap in Patient Safety Programme).

Yes / The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. Method 490 adult patients in nine primary care practices in Greater Manchester, UK, completed the PC PMOS. Practice staff (n = 81) completed a survey on patient safety culture to assess convergent validity. Confirmatory factor analysis (CFA) assessed the construct validity and internal reliability of the PC PMOS domains and items. A multivariate analysis of variance was conducted to assess discriminant validity, and Spearman correlation was conducted to establish test–retest reliability. Results Initial CFA results showed data did not fit the model well (a chi-square to df ratio (CMIN/DF) = 5.68; goodness-of-fit index (GFI) = 0.61, CFI = 0.57, SRMR = 0.13  and root mean square error of approximation (RMSEA) = 0.10). On the basis of large modification indices (>10), standardised residuals >± 2.58 and assessment of item content; 22 items were removed. This revised nine-factor model (28 items) was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04  and RMSEA = 0.05). New factors demonstrated good internal reliability with average inter-item correlations ranging from 0.20 to 0.70. The PC PMOS demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, p < 0.001) and showed some association with practice staff safety score (convergent validity) but failed to reach statistical significance (r = −0.64, k = 9, p = 0.06). Conclusion This study led to a reliable and valid 28-item PC PMOS. It could enhance or complement current data collection methods used in primary care to identify and prevent error. / NIHR Greater Manchester Patient Safety Translational Research Centre.

Abstract The Act on the Status and Rights of patients (1993) enabled a change in the patient’s status from being a passive object of medical treatment to being an active and equal subject with a right of self-determination. According to the Act a patient has a right to show his dissatisfaction with the received care and treatment with a complaint. The aim of the first part of the study was to clarify the workings of patient feedback and complaint systems as well as the position of the health care professionals with whom patients had been dissatisfied with. The data was collected with a questionnaire from people in superior positions within the medical and nursing professions (n = 110). The aim for the second and third parts of this study was to find out about patients’ dissatisfaction with the medical care, nursing or treatment they received from a health care professional. Data for the second part of the study was collected from readers’ letters in newspapers during 2012 (n = 127), while the data for the third part was gathered from patients’ complaints during 1993-2012 (n = 956). The data for parts were analyzed by means of inductive content analysis. The results from the questionnaire show that a complaint is a negative thing. Sorting out of the facts concerning the matter and answering the complaint are felt to be slow and complicated. Patient feedback is seen as a more natural alternative to a complaint from the viewpoints of the patient, the health care professional and the working community. Dissatisfaction expressed by a patient is also a defeat for a health care professional. There is a lot of dissatisfaction with care and treatment in the readers’ letters concerning health care. To a great extent, it deals with access to health care, with the abilities of health care professionals and with general treatment. The amount of complaints increased significantly between years 1993–2012. However, the amount was small when compared to the number of patients then in health care. The complaints were mostly made by patients themselves. The main sources for dissatisfaction with health care are gaining access to health care, the professional abilities of health care staff as well as guidance and getting advice. Dissatisfaction with treatment is expressed as experiences of having been dominated or subjected to mental violence. Dissatisfaction with the health care organization is rare in all parts of the study. The experienced care is more significant than the environment. The content of complaints has not been studied before. The knowledge gained by this study can be utilized when developing the statutes on the complaints and feedback systems. The study also gives new insight into developing patient encounters as well as nursing and well-being at work. / Tiivistelmä Potilaslaki (1993) mahdollisti, että potilaan asema muuttui passiivisesta hoidon kohteena olevasta objektista aktiiviseksi ja tasa-arvoiseksi toimijaksi. Potilaslain mukaan potilaalla on oikeus osoittaa tyytymättömyytensä saamansa hoitoon ja kohteluun muistutuksen avulla. Ensimmäisen osastutkimuksen tarkoituksena oli selvittää potilaspalaute- ja muistutusjärjestelmiä sekä potilaan tyytymättömyyden kohteeksi joutuneen terveydenhuollon ammattihenkilökunnan asemaa. Aineisto kerättiin kyselyllä hoitotyön ja lääketieteen esimiehiltä (n = 110). Toisen ja kolmannen osatutkimuksen tarkoituksena oli selvittää potilaan kokemaa tyytymättömyyttä terveydenhuollon ammattihenkilön harjoittamaan terveyden- ja sairaanhoitoon tai siihen liittyvään kohteluun. Toisen osatutkimuksen aineisto kerättiin yleisönosaston mielipidekirjoituksista vuoden 2012 ajalta (n = 127) ja kolmannen osatutkimuksen aineisto muistutuksista vuosilta 1993–2012 (n = 956). Osatutkimusten aineistot analysoitiin induktiivisella sisällönanalyysillä. Kyselyn tulosten mukaan muistutus on luonteeltaan kielteinen. Siihen liittyvien asioiden selvittely ja vastauksen laadinta koetaan hitaaksi ja monimutkaiseksi. Potilaspalautetta pidetään potilaan, työntekijän ja työyhteisön kannalta muistutusta luontevampana vaihtoehtona. Potilaan ilmaisema tyytymättömyys on tappio myös terveydenhuollon ammattihenkilölle. Terveydenhuoltoa koskevissa mielipidekirjoituksissa esiintyy paljon tyytymättömyyttä hoitoon ja kohteluun. Se kohdistuu suurelta osin hoitoon pääsyyn liittyviin asioihin sekä henkilökunnan osaamiseen ja kohteluun. Muistutusten määrä kasvoi vuosina 1993–2012 merkittävästi. Silti niiden määrä on vähäinen verrattuna hoidossa olleiden potilaiden määrään. Muistutukset olivat enimmäkseen potilaiden itsensä tekemiä. Hoitoon liittyvää tyytymättömyyttä aiheuttavat erityisesti hoitoon pääsyyn, henkilökunnan osaamiseen sekä ohjaukseen ja neuvontaan liittyvät asiat. Kohteluun liittyvä tyytymättömyys ilmenee kokemuksena alistamisesta ja henkisestä väkivallasta. Organisaatioon liittyvä tyytymättömyys on kaikissa osatutkimuksissa vähäistä. Koettu huolenpito on ympäristöä merkityksellisempi. Muistutusten sisältöä ei ole aikaisemmin tutkittu. Tutkimusta voidaan hyödyntää muistutuksiin liittyvien säädöksien ja palautejärjestelmien kehittämisessä. Tutkimus antaa uutta tietoa myös potilaan kohtaamiseen sekä hoitotyön ja työhyvinvoinnin kehittämiseen.