Explaining Patient Safety – cultural models as barriers, and how to overcome them

Many of us think of patient safety as a high priority for the health system but misconceptions about patient safety are common. We need to bridge the gap between the messages people hear and what the patient safety community understands. Experts know that most medical harm can be traced to systemic problems but the public sees sensational stories about individuals and the mistakes they have made. A recent WIHI podcast explores how to better communicate patient safety issues, based on new research.

M.E. Malone, from the Betsy Lehman Patient Safety Center explains that standing in the way of improved understanding are filters or models – preconceived and/or deep-seated notions that people bring to a topic and that affect communication.

The “caring doctor model” is the idea that if professionals are well-intentioned and know their patients, then adverse events won’t happen. You will be safe as long as you choose the right, caring doctor. When this model is established it is hard to persuade the public that bigger improvements are needed.

The “to err is human” model says that because medicine is performed by humans for other humans, mistakes are inevitable. This leads to fatalism as harm is inevitable and people do not understand that if we invest time and resources we can make a difference.

Thirdly, the “monitor and punish model” is the belief that weeding out the “bad apples” –  removing underqualified practitioners – is the best or only route to safer care. This is also a generally unproductive way to think about patient safety.

These cultural models have great staying power, they are easy stories to tell and they pervade the media. Fortunately research is helping establish better ways to communicate. Rose Hendricks, a researcher from the FrameWorks Institute suggests the following:

1. Make it clear that we are referring to preventable events, not just any cause of harm. Define the terms with concrete examples e.g. an allergic reaction. Be clearer what are we talking about when we discuss medical errors
2. Connect the dots between causes and solutions. Experts know but the public doesn’t see the links. For example, when doctors lack information, the solution may be information technology to improve communications. When patients don’t feel they can speak up about potential safety issues, the solution is for them to be ‘activated’ i.e. feel encouraged to voice concerns. When important steps in procedures are skipped, checklists and protocols can help.
3. An efficacious tone is helpful, signaling “we can do this” – we can have an effect on patient safety. The right tone combats the sense of fatalism and tends to be more effective than talk of a crisis.
4. When speaking about the prevalence of errors or preventable harm don’t throw out a statistic on its own. It is preferable to communicate that there are “many” events, rather than an exact figure whose context and meaning may be difficult to explain.
5. Explanatory metaphors that make concepts more tangible are helpful. The comparison to aviation is commonly applied. It can help explain causes and certain kinds of solutions but with caveats ,for example the language of “customers”, (e.g. “getting what you pay for”) may be inappropriate, we should steer clear of consumerism and focus on the safety aspects.
6. “Empowerment” as a term is not helpful and can backfire. Patient empowerment is one of the solutions for patient safety problems, but we have to find ways to communicate the idea without the term.
7. Finally, the metaphor of a “failsafe” mechanism or system is useful – a quick, concise ways to communicate patient safety as being about finding things that can kick in before harm is caused. This term can be used to think and elaborate on solutions including those involving technology.

What cultural models of patient safety are prevalent in South Africa, and how are we communicating these issues to the public? It seems that headlines pointing figures at individuals, whether practitioners or officials, are common and productive analyses of systemic issues and how they might be addressed sadly are rare.

Links:

1. Re-framing patient safety (Betsy Lehman Center for Patient Safety)
2. How to Make Patient Safety Easier to Explain and to Champion. WIHI podcast, March 2019.