The Social Context of Patient Safety Risks for People Living with Multiple Health Conditions

Contemporary research in patient safety has tended to focus on clinical systems and processes. However, an increasing body of research from ambulatory (as opposed to inpatient) medicine has underlined the relationships and human factors involved in keeping patients safe. One contemporary strand of sociological interest has pointed to the ways in which patient safety is a subjective or co-produced 'feeling' maintained and negotiated in interactions with health workers who are judged on their approachability, knowledge and behaviour.

Against this background we report the results of a qualitative interview study of 37 people living with multiple health conditions in England and Wales. The study set out to broadly capture patients’ experiences of ‘multimorbidity’ and the health service response. Even though the interviews were not focused on patient safety, a range of harms were spontaneously mentioned by some participants alongside judgements of the inappropriate behaviour of health workers.

Ethical approval was obtained prior to the study. Transcripts from semi-structured video and audio interviews were transcribed using a framework based on known issues in primary care patient safety from existing studies (communication, access, relationships and technical issues). Transcripts were also examined for interviewees’ subjective perceptions of risk and safety. The Quirkos software package was used to manage the coding process.

The findings underline the social context of risk for patients with multimorbidity. Patients with multiple health problems need multiple inputs, which exposes them to increased risks of harm or (perceived) assault or incompetence. Increasing involvement with medicine can also bring risks of increasing uncertainty with attendant worries and anxieties. However, more tangible risks—such as falling down the stairs or dealing with drug side-effects—lie in the domestic sphere. In this paper, we use patients’ articulations of risk to partly deconstruct a biomedical conception of “safety” for patients living with multiple long-term conditions.