Emotional safety: The forgotten aspect of patient safety

In an earlier blog I wrote about who is best to identify patient safety issues, and the evidence was clear that patients are in a better position to do this than staff  (https://www.careopinion.org.au/blogposts/114/identifying-patient-safety-issues---who-does-it-better-staff). In this research the patient safety outcome was defined as hospital mortality. But is patient safety solely about dying or not? A recent paper by Lyndon and her colleagues from the New York University would suggest not. (https://qualitysafety.bmj.com/content/early/2023/02/02/bmjqs-2022-015573)

The authors explored patients’ conceptualisation of safety across three UK teaching hospital inpatient specialty wards in a qualitative interview study. The authors found that patients in their study conceptualise safety as ‘feeling safe’ rather than ‘being safe’.  ‘Being safe’ is characterised by minimising the risk of patient harm. However, ‘feeling safe’ is more about emotional safety or ‘patient experience’.  Some of the consequences of ‘not feeling safe’ are fear, mistrust, medical trauma, loss of confidence in the healthcare provider and/or healthcare system and decreased healthcare utilisation.

There is ample evidence of the ways in which patients are made to feel unsafe in healthcare. Patients routinely experience disrespect, may have their physical autonomy violated while in a structurally vulnerable position, have their concerns dismissed, and be subjected to abuse, racism, sexism, and classism. A familiar example in Australian healthcare is the treatment of Aboriginal patients and their sense of not ‘feeling safe’ despite their being no apparent patient harm.

The study findings are consistent with prior studies indicating patients conceptualise safety differently from clinicians and that from the patients’ and families’ perspective; ‘patient experience’ and ‘patient safety’ are fundamentally intertwined.

A number of stories on Care Opinion (www.careopinion.org.au) demonstrate this differentiation. For example, in this story https://www.careopinion.org.au/89890 the patient says that although the immunology team and nurses were helpful, their placement in a bed next to a patient who was dying was extremely distressing.  Although clinical aspects of the care appear to have been met, this patient was distraught by the end of their stay due to the emotional strain of not only hearing the patient beside them pass, but also be present when their family were coming to say goodbye.

Another story (https://www.careopinion.org.au/89919) about pre-anaesthetic advice describes the patient’s anxiety going into a surgery with conflicting information about their medication before surgery. This patient describes the surgery as exemplary but they have tagged this story with feeling ‘unsafe’.

And this storyteller highlights their ‘patient safety’ issue about their care (https://www.careopinion.org.au/87995).  Although they commented that the clinical treatment from medical and allied health staff was impressive, they were left feeling exposed due to a lack of equipment/facilities which meant they had to be transferred to the toilet with only a towel covering them (no pants).

The above examples point to ‘emotional safety’ being a key part of ‘patient safety’. Care Opinion, through the medium of storytelling, is available to support patients, their carers, families and friends, to express their levels of ‘emotional safety’ or ‘feeling safe’, not just ‘being safe’.