In any professional endeavour there are buzzwords, words of the moment that drive policy making and practice. Over the years in the NHS, I have seen such words and phrases as, patient advocacy, controls assurance, clinical governance, shared blame culture and so on used in the context of patient safety. These words can be seen to instigate and drive patient safety policy making and practice for a period and then they seem to disappear. They occasionally re-emerge, refreshed, and help drive again patient safety policy making and practice.
Patient empowerment falls into this category of NHS buzzwords, and it has enjoyed a great deal of longevity as a driving policy and practice change concept in the NHS. Like any buzzword it is capable of several different meanings, and it is used a lot. This is a key advantage of buzzwords. They have wide, generic, and diffuse meanings. People can attribute many different meanings to them and can understand them differently. I have said before in this column that it is the idea behind the label that matters and not necessarily the label itself. There is a need to debate and discuss meaning and go beyond the mere label.
Debating and discussing meaning
When we use concepts such as patient empowerment, we need to be as specific as we can about what we mean and understand about the term. We don't want the words to be just seen as a convenient ‘clarion call for change’ label, without saying what we want to change and why.
Cribb et al have pointed out the challenges that multiple understandings of justice create:
‘The core question for all those interested in designing and implementing more “just” safety policies and procedures is working out which conceptions of justice they should work with and emphasise. We cannot just “pick” one conception of justice and neglect the others because they each make a relevant claim on us.’
We need to move away from possibly knee-jerk assumptions of what we mean by these concepts and to debate and explore competing conceptions. Otherwise, the terms can become too vague and meaningless:
‘We contend that part of the ongoing muddle about safety cultures stems from this lack of focused attention on the nature and implications of justice in the field of patient safety. Put simply, we need to talk about justice.’
A crowded field
This is all much easier said than done when we look at the wealth of literature, both national and international, on patient empowerment and in patient safety generally. I have said before in my columns that patient safety has become a large global service industry with many competing stakeholders. Some stakeholders' agendas, however, may not be shared by all, and debate and discussion are essential to tease out, understand, reflect on the advice given and its applicability to health care systems such as the NHS. There cannot in my view be a one-size-fits-all approach to patient safety policy making, practice and patient empowerment.
The tidal flow of patient safety information and reports, including those relating to patient empowerment, seem set to continue unabated, raising the question of how busy NHS staff – often working in resource-constrained environments – are meant to keep up to date.
Global perspectives
Although it can be challenging for NHS and other healthcare staff to keep up to date with the wealth of patient safety reports published in the UK, there is also a lot going on globally in this area.
The topic for the latest World Health Organization (WHO) World Patient Safety Day, which happens annually on 17 September, was ‘Engaging Patients for Patient Safety’. The idea behind the day this year was to highlight the importance of involving patients, families and care givers in patient safety efforts (WHO, 2023). Also, to engage policymakers, leaders, and others to do this along with patients. National landmarks in some countries were lit up to mark the day and special conferences and other events took place. WHO also has its Global Patient Safety Action Plan 2021–2030. A guiding principle of the framework is to ‘engage patients and families as partners in self care’:
‘Safe health care should be seen as a basic human right. As health care is predominantly a service, it is always co-produced with the users. Achieving safe care requires that patients be informed, involved, and treated as full partners in their own care.’
This create an international momentum for developing and enhancing patient empowerment initiatives globally. More recently the Organisation for Economic Co-operation and Development (OECD), published a report on patient engagement for improving patient safety (Kendir et al, 2023). This gives a global perspective on the issue, highlighting what several countries are doing in this area. Also, there is a discussion of the scope and costs of litigation related to medical malpractice and experiences of harms in health care.
Findings included that as many as 1 in 6 patients reported safety incidents, and up to 8% of patients experienced medication errors. The authors found that there was limited information available regarding the cost of unsafe care relevant to patients. On no-fault liability systems, they said:
‘Less than half of countries (9 out of 21) [who] responded to the OECD survey on Patient Engagement for Patient Safety reported having systems of no-fault liability in place to compensate patients who suffer any treatment-induced injury irrespective of conviction for medical malpractice or negligence. Countries that indicated having a system of no-fault compensation to patients include Austria, Belgium, France, Japan, Korea, Latvia, New Zealand, Portugal, and Switzerland.’
Several key recommendations are made in the report for enhancing patient engagement for patient safety, which include:
- Building trust for safer healthcare through stronger patient and family engagement
- Institutionalising patient engagement for patient safety
- Improving quality of patient-reported safety indicators and systematically using them for improving patient safety.
The report provides useful comparative data of what countries are doing in this critical area. A comparative approach to patient safety, patient empowerment, and legal issues is a valuable one as we can usefully stand back, take time out and reflect on what others are doing in the area. This can all help inform NHS patient safety policy making and practice.
Patient empowerment and health care digital technologies
Closer to home, the NHS Confederation and Google Health (2023) have recently published a report on patient empowerment and the role of digital technologies. COVID-19 brought what could be regarded as a sea change in the attitude of many patients to accessing GP services. Consultations by remote technologies, and the COVID tracing app are just two notable features of this. In England, we now have the NHS App to access health services. Today patients seem more tolerant and comfortable with digital technologies, but some patient groups can experience challenges. There is a clear link here with patient empowerment. If tests can be done remotely without a visit to the GP or hospital then that would seem automatically to give the patient more control, autonomy, or empowerment. They can manage their life better and feel less dependent on others. These points are discussed by the NHS Confederation and Google Health (2023), which highlights the need to help increase patient confidence in the use of digital technologies.
NHS Confederation and Google Health (2023) commissioned Ipsos, a market research company, to undertake research to see what the public's attitudes, understanding and beliefs were about responsibility and control over their health. The research also aimed to explore the impact of health technologies, citizen expectations and ambitions. Ipsos conducted an online survey among 1037 adults (18+) in the UK with some having long-term health conditions.
The report is clear, well-structured and contains key insights and information about digital technologies and health, current and future challenges, and opportunities. Overall, it takes an optimistic tone. Key findings include that 97% of individuals surveyed considered themselves responsible for their health. Six in 10 (63%) felt they had a great deal of or total control over their wellbeing, and 8 in 10 (83%) use technology for their health management. The report states that nearly 4 in 5 (79%) would be happy to use technology to manage their health if recommended by the NHS. However, 71% of patients with long-term conditions preferred to get advice directly from their doctors before turning to technology.
Inpatient surveys
Patient satisfaction surveys can be a good barometer of the success or otherwise of NHS patient empowerment strategies. The latest adult inpatient survey for England (Care Quality Commission, 2023) has positive findings in terms of patient interactions with nurses and doctors and involvement in care:
‘Most people (72% for doctors and 73% for nurses) said they ‘always’ got answers to their questions they could understand, although this has decreased for both doctors (73% in 2021) and nurses (74% in 2021) … When asked about being included in conversations, 74% said doctors ‘always’ included them and 75% said this for nurses, compared with 73% and 75% respectively in 2021.’
In terms of patient empowerment, we can see from the survey report good indications about how the relationship between health professionals and patients is working out, in the context of inpatient care. If patients did not feel professionals were answering their questions properly or they lacked trust in those who were treating them, this would indicate acute problems in the relationship and balance of power between them.
Conclusion
Patient empowerment can be termed a buzzword as it is so frequently used in the literature and in professional practice. We do, however, need some degree of specificity when discussing the term. To unpack meaning and application properly we need discussion and debate. Patient empowerment can be seen as a vital component of any healthcare system. A comparative global analysis of patient empowerment initiatives and strategies can yield valuable insights for NHS patient safety policy makers and healthcare practitioners. We have some good examples and useful commentary on current and future trajectories of patient empowerment in terms of digital technologies. And the inpatient survey provides real time, practical examples of how the concept can be seen to be operating in a section of the NHS. Patient empowerment is an important issue and is one which continues to attract reports and publications.