Putting the patient at the heart of patient safety: Implementing a Patient Measure of safety with hospital volunteers (PRASE)

Lead:      Dr Jane O’Hara (University of Leeds/BIHR)

Collaborators:  Dr Gemma Louch (BIHR); Professor Rebecca Lawton; Professor Mohammed Mohammed (University of Bradford/BIHR)

Background: The Patient Reporting and Action for a Safe Environment (PRASE) Intervention is a novel patient measure of hospital safety. It allows patients to provide feedback on their care, for ward staff to use to facilitate local action planning and safety improvement. Feedback from patients is well established through satisfaction or experience surveys. However, no routine measure exists allowing inpatients to provide feedback on the safety of care. As a research project, the PRASE data has been collected by research nurses. In this project we harnessed the untapped potential of hospital volunteers to promote wider implementation of PRASE and put patients at the heart of safety.

Rationale: There is growing recognition that patient involvement is central to the quality of healthcare. Patients are in a unique position to give detailed insight into the quality and safety of the care they receive. The Patient Reporting and Action for a Safe Environment (PRASE) Intervention is a patient centered process for systematically collecting patients to provide feedback on their care. Ward staff can then use this feedback in their local action planning and safety improvement activities. An improvement project led by Bradford Teaching Hospitals NHS Foundation Trust aims to harness the as yet untapped potential of hospital volunteers, to promote wider implementation and sustainability of the PRASE Intervention. Researchers from the Yorkshire Quality and Safety Research Group are leading the evaluation of this improvement project. 

Research Questions addressed: 
  • Is it feasible and acceptable for hospital volunteers to collect patient feedback about the safety of their care, using the tools within the PRASE intervention?
  • Does PRASE intervention data collected by patient volunteers improve patient safety on hospital wards? 

Methods of investigation: The evaluation was divided into two distinct phases of project implementation. During phase 1 (July 2014 – June 2015), a formative evaluation process assessed the implementation of the PRASE intervention measurement tools on pilot wards across three NHS Trusts. This part of the evaluation aimed to explore whether hospital volunteers can be used to collect PRASE data. The researchers sought to understand the experience of both hospital volunteers and Health Professionals (HPs) in the collection of patient feedback, and this understanding was used to refine the process of recruitment and training of hospital volunteers. In phase 2 (June 2015 – July 2016) the PRASE intervention was rolled out to multiple wards across the three NHS Trusts, and we undertook a summative evaluation of the implementation process. We examined whether patient feedback collected by hospital volunteers led to patient safety improvements, and how the intervention was conducted. 

The project was funded by The Health Foundation as part of their ‘Closing the Gap in Patient Safety’ programme..  

Outputs:

HSRUK Conference July 2016: Lessons from Evaluating Improvement: The PRASE Intervention in Collaboration with Hospital Volunteers 

Publications:

Louch, G., O'hara, J., & Mohammed, M. A. (2017). A qualitative formative evaluation of a patientcentred patient safety intervention delivered in collaboration with hospital volunteers. Health Expectations20(5), 1143-1153.

Louch,G, Mohammed, M.A. , Hughes, L., O’Hara, J (2018)  “Change is what can actually make the tough times better”: A patient-centred patient safety intervention delivered in collaboration with hospital volunteers. Health Expectations

O’Hara, Jane K., Rebecca J. Lawton, Gerry Armitage, Laura Sheard, Claire Marsh, Kim Cocks, Rosie RC McEachan, Caroline Reynolds, Ian Watt, and John Wright. "The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study." BMC health services research 16, no. 1 (2016): 676.

Armitage, G., Moore, S., Reynolds, C., Laloë, P. A., Coulson, C., McEachan, R., ... & O’Hara, J. (2017). Patient-reported safety incidents as a new source of patient safety data: an exploratory comparative study in an acute hospital in England. Journal of Health Services Research & Policy, 1355819617727563.

Lawton, R., O Hara,J, Sheard, L., Armitage, G., Cocks, K., Buckley, H., Corbacho, B., Reynolds, C., Marsh, C., Moore, S., Watt, I., Wright, J (2017) Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention. BMJ Quality and Safety 2017 Feb 3. 

O'Hara, J. K., Armitage, G., Reynolds, C., Coulson, C., Thorp, L., Din, I., ... & Wright, J. (2017). How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms. BMJ Qual Saf26(1), 42-53.

O’Hara, J. K., Reynolds, C., Moore, S., Armitage, G., Sheard, L., Marsh, C., ... & Lawton, R. (2018). What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study. BMJ Qual Saf, bmjqs-2017.