Implementing co-production to enhance patient safety: the introduction of the patient safety consent tool, an example of a simple local solution to a common challenge.

Abstract

Zero harm is one of the priorities that all healthcare systems are aspiring for. However, more than two decades after 'To Err is Human' report, many systems are struggling to identify or implement strategies to achieve this important goal [1]. One of the very powerful, yet underutilized strategies towards transforming patient safety and achieving Zero Harm is 'co-production' [2]. Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations' [2]. Simply put, co-production means that patients contribute alongside professionals to the provision of health services [3]. While we know the importance and potential value of co-production, many health systems are underutilizing the approach. Actions to effectively implement and sustain changes to service provision to use co-production are elusive [4]. To realize improvements, a key requirement for health professionals is addressing the question: how can we implement and sustain co-production in efficient, effective ways? To address this challenge, and thereby improve patient safety and work towards zero harm, we introduce the 'Patient Safety Consent' (PSC) tool, a simple co-production tool to empower patients and families to become more active members in their own healthcare. Implementing the co-production of care, requires a shift in the traditional attitudes and power dynamics between healthcare professionals and patients [2]. Professionals explicitly share service information, diagnosis assessments, treatment options, decision-making and involve patients and their families in determining the direction and actions for their care; conversely, patients and families take on an active role in engaging in discussions, potential care pathways, and ongoing decisions about their treatment and care. Hence, the PSC tool is a direct, engaging, comprehensive and, where used effectively, a powerful strategy for changing the dynamics and outcomes of care. The co-production process using the PSC tool involves engaging the patient/family in discussing and recording the patient risk profile. This means addressing potential clinical risks that could take place during the care process such as: venous thromboembolism; patient falls; hospital acquired infections (HAIs); medication side effects or errors; and, adverse events that are specific to the patient and their treatment plan. The patient risk profile is also a tool for the care team to assess and understand an individual patient's self-care ability, capacity for comprehending medical information, treatment directions and decisions, their goals from treatment and, emotional and psychological resilience. Once the patient risk profile is identified and recorded, the co-production process continues by determining the responsibilities of the patient/families and different healthcare professionals on how to monitor, prevent and, where necessary, respond and alleviate them. The PSC tool recognizes that a patient's thoughts, emotions, expectations, needs and resilience changes during the care process; hence is it an evolving document that is updated regularly across the care process. The PSC tool integrates and personalizes the responsibilities of patients/families and healthcare professionals across the three phases of the patient journey: 1. Pre-admission phase; 2. Admission (hospital) Phase; 3. Post-discharge phase. 1.Pre-admission phase: during this phase, together the healthcare professionals and patient/family assess the patient risk profile, based on their medical history and treatment plan, recording the details on the Patient Safety Consent form. 2. Admission phase: on admission to the ward the care team and patient review the Patient Safety Consent form to confirm the details and ensure its implementation. These tasks can involve, as necessary, (re)assessing potential risks, the responsibilities of each person, and how and when the PSC approach will be reviewed. 3. Post-discharge phase: during the discharge phase, the care team discuss and document with the patient/family outcomes, ongoing care actions, future medical requirements and potential risks and remedy actions. Successful implementation of a co-production strategy or tools that challenge and change practice, such as the PSC tool, requires a project to create a 'learning health system' [2]. Making co-production a consistent, standard philosophy and behavior in care practice necessitates: strong organizational endorsement support, including support and adoption by managers; education and training of healthcare personnel to change practice interactions; planning and integration into care processes, supervision arrangements and information systems; evolution of organizational and services cultures; investigation of staff and patient experiences; and, ongoing review and evaluation of the project. There are important research studies into health systems driving such changes: see the collaborative, comparative work in Sweden and England [4]. In conclusion, we know that co-production in healthcare has a positive impact on patient safety, and experience, and staff wellbeing [2]. By bringing patients and professionals together and placing the patient at the center of the care process, co-production creates a more collaborative, and transparent healthcare system. Developing and translating co-production strategies into specific tools, such as PSC tool, standardizes and institutionalizes new expectations, behaviors and cultures to improve patient care and outcomes.