Abstract
BackgroundThere is a need to ensure that the risks associated with medication usage in primary health care are controlled. To maintain an understanding of the risks, health‐care organizations may engage in a process known as “mindful organizing.” While this is typically conceived of as involving organizational members, it may in the health‐care context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety.MethodQualitative focus groups and interviews were carried out with 126 members of the public in North West England and the East Midlands. Participants were taking medicines for a long‐term health condition, were taking several medicines, had previously encountered problems with their medication or were caring for another person in any of these categories. Participants described their experiences of dealing with medication‐related concerns. The transcripts were analysed using a thematic method.ResultsWe identified 4 themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with health‐care professionals; and the relationship between patients and the health‐care system (in particular, mutual trust).ConclusionsMindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and are strengthened by) patients’ engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement.
Highlights
There is a need to ensure that the risks associated with medication usage in primary health care are controlled
We examine how one theory that has been applied to organizational safety can be used to understand patient involvement in medication safety
Our findings illustrate that patients could potentially contribute to the “mindfulness” of medicines management. This potential is realized through 4 interacting processes: assimilating and applying knowledge about medication risks; communicating with health-care professionals; using artefacts; and recognizing the level of trust that can be placed in each of the parties involved
Summary
Medicines can prevent or treat many conditions and so are the most common intervention in health care, with over 1 billion prescription items being issued in English primary care each year.[1]. Vogus & Sutcliffe[12] proposed “mindful organizing” as a collective mental orientation in which the organization continually engages with its environment, reorganizing its structures and activities as necessary, rather than mindlessly executing plans in ignorance of the prevailing circumstances This is a dynamic social process, consisting of specific actions and interactions between those engaged in frontline organizational work. While there appears to be convergence between the various concepts described here (i.e. high-reliability organizing, resilience and safety culture), a particular insight offered by the literature on mindful organizing is to emphasize its grounding in social relations.[23,24,25] In other words, the collective capacity to understand, anticipate and respond to problems both depends on and subsequently provides a structure for social interactions such as collaboration and negotiation.[23,26] The potential relevance of this insight to patient safety is demonstrated by examining the issue of patient involvement. We drew from primary care patients’ experiences of dealing with medication safety issues
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