Exploring the nexus of patient safety and patient-centredness


Visiting US researcher Kristina Weeks is identifying the characteristics and processes in NSW hospitals that may help or hinder practitioners to provide safe, patient-centred care.

Kristina Weeks

Kristina Weeks


A consumer representative recently stated to a crowded room of healthcare professionals: “I am an expert on my body, all you have to do is ask me”.

The statement highlights a renewed attention to the role that patients play in their care. It is a call to combine the modern marvels of medicine with patient input to increase the likelihood that the care delivered is safe, effective, and what patients want.

There is a growing body of evidence that says including patients and consumers as partners in the care team can decrease the chances of patient harm and improve outcomes. One recent review showed positive associations between patient experience and patient safety and clinical effectiveness. 1

Another study demonstrated that engagement of employees and physicians plays a crucial role in driving improvements in patient experience as well as quality, safety, and financial performance.2

Indeed, policy makers, practitioners, and patients alike stand to benefit most from the implementation of rigorous, thoughtful approaches to examine safety risks that are informed by the needs of clinicians and patients.

The research I am currently undertaking in NSW focuses on identifying the characteristics and processes of healthcare organisations that help or hinder practitioners in achieving the goal of providing safe, patient-centred care.

Clinicians and patients sometimes have mismatched perceptions of the quality of care delivered, and communication errors are globally recognised as key contributors to patient harm. Many clinicians feel mounting pressure to “do more with less” in an increasingly complex clinical environment, and simultaneously, there are recurrent reports showing that patients feel they are not listened to or heard.

Both patients and providers can agree that there is a need for change but the question is how.

New ways of hearing patients’ voices

The Australian and US health systems, like many other advanced healthcare systems, assess patient perceptions of their care experiences and levels of satisfaction.

Some hospitals are using different types of approaches and data to reap the benefits of including patients in their care. Reports of experiences may come long after patients have already gone home.

Leaders in implementing quality and safety initiatives have created programs such as the Clinical Excellence Commission’s REACH program that empowers patients and families to escalate concerns about their care while they are still in the hospital.

Another program at Johns Hopkins University in the US engages with patients and carers on how they can play a part in safe surgery.3 Patients and their families learn about the importance of bathing with specific antiseptic skin cleansers before arriving at operating theatre to prevent the chance of infection related to surgery. Increased uptake in recommended activities has seen patients go home sooner, more positive reports of care experiences and lower rates of surgical site infections. Hospital managers have also noted the decrease in costs associated with the surgeries. Learning from the success of others can be an efficient way of charting a new course.

Trumpeting the lessons learned from tall poppies

One of my earlier observations upon arriving in Australia six months ago was people’s tendency to shy away from touting their accomplishments.There seemed to be a particular skill in the use of self-deprecating humour when talking about one’s performance, especially if it was about demonstrated success.

I now know that it is a well-known phenomenon to avoid standing out and the accompanying risk of having your achievements criticised or cut down – so called “tall poppy syndrome”.

Recognising the sensitivities of the delicate balance many face in being perceived as outstanding while not becoming a target of negative criticism, my study aims to identify exemplary hospitals which are both safe and patient-centred. The lessons learned from those identified will serve as examples of what can be done rather than absolute prescriptions for others to follow.

The organisations were identified using publicly reported data including patient and staff perceptions and consensus-based quality metrics. Through site visits and interviews at each of the sites, I will summarise underlying factors that might explain their high performance and share themes, similar approaches, and strategies currently being deployed across NSW to realise safe, patient-centred care.

Policy Implications

It is possible that each of the high-performing organisations I identify may have an approach that is unique to their setting, but I will also be exploring the influence of policy levers like national standards and accreditation in guiding successful efforts.

I also plan to investigate whether the strategies and approaches used by these high performers can be extrapolated to others – both in Australia and perhaps in the United States.

While ongoing innovations in science and technology will continue to benefit from the inclusion of patients and their families, they can also be driven by them.


  1. Doyle C, Lennox L, Bell D. A systematic review of the evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013;3:e001570 doi:10.1136/bmjopen-2012-001570
  2. Cochrane BS, Hagins M, King JA, Picciano G, McCafferty MM, et al. Back to the future Patient experience and the link to quality, safety, and financial performance.Healthcare Management Forum. 2015; 28(6)S47‒S58
  3. Wick, EC, Galante DJ, Hobson DB, Benson AR, Lee KHK, et al. Organizational culture changes result in improvement in patient-centered outcomes: implementation of an integrated recovery pathway for surgical patients. Journal of the American College of Surgeons 2015:221;669‒77

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*This work was supported by the Australian-American Fellowship in Health Policy awarded to Kristina Weeks by The Commonwealth of Australia and the Commonwealth Fund. The views presented are those of the author and should not be attributed to Commonwealth of Australia, The Commonwealth Fund, or its directors, officers or staff.


Ms Weeks is a member of the faculty in the Department of Medicine at Johns Hopkins School of Medicine in the US, a doctoral candidate in the Johns Hopkins Bloomberg School of Public Health, and is currently working with the Clinical Excellence Commission, NSW as part of an Australian-American Health Policy Fellowship*.


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