Over the last decade a wealth of studies have explored the way that patients are involved in patient safety internationally. Most begin from the premise that patients can and should take on the role of identifying and reporting safety concerns. Most give little attention, however, to the impact of the patient’s health status and vulnerability on their ability to participate in their safety. Drawing on qualitative interviews with 28 acute medical patients, this article aims to demonstrate how patients’ contributions to their safety in the acute medical context are less about involvement as a deliberate intervention, and more about how patients manage their own vulnerability in their interactions with staff. Our analysis is underpinned by theories of vulnerability and risk. This enables us to provide a deeper understanding of the ways vulnerability shapes patients’ involvement in their safety. Acute medical patients engage in reassurance-seeking, relational and vigilance work to manage their vulnerability. Patients undertake reassurance seeking to obtain evidence that they can trust the organisation and the professionals who work in it and relational and vigilance work to manage the vulnerability associated with dependence on others and the unpredictability of their status as acute medical patients. We argue that patients are involved in the process of creating patient safety at the point of care. Foregrounding the theory of vulnerability and its relationship to risk offers new insights into the potentials and limits of patient involvement in patient safety in the acute care context.
Dr Liz Sutton is a Research Associate in the Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester. She has considerable expertise in qualitative research including: qualitative interviewing, focus group facilitation and ethnography. Her ethnographic projects have been conducted in different settings including hospital acute care and in care homes, where she has explored such issues as the quality and safety of care and how context affects antibiotic prescribing. Her PhD research explored how vulnerability affects patient involvement in patient safety. Her other interests include dementia care, healthcare quality improvement and health inequalities.