How vulnerability affects the co-creation of patient safety: Views of healthcare professionals and acute medical patients

The aim of this thesis is to explore the views of acute medical patients and healthcare professionals on the role of vulnerability in patient safety.

Drawing on secondary analysis of qualitative interviews with healthcare professionals and newly collected interviews with acute medical patients and relatives, I explore the way in which vulnerability impacts on the interactions between healthcare professionals and acute medical patients.

Employing a thematic analysis informed by theories including the sick role, performativity and risk work, I reveal the problematic nature of patient involvement at the point of care from the healthcare professionals’ and patient perspective. Healthcare staff believe that patient vulnerability is a barrier to raising concerns at the point of care and favour confidential feedback as an approach to involvement that overcomes that vulnerability. Their views on organisational responses to involvement highlight the extent to which involvement is often formal, planned and reactive.

Interviews with patients and relatives show that patients’ understandings of safety arise from their vulnerability to their illness, their uncertain situations and their dependence on others. In order to feel safe, patients need reassurance that they are cared for, and that staff are acting in their best interests and following the right procedures. Adopting the sick role enables acute medical patients to demonstrate their entitlement to care. Through performing vulnerability, patients are able to generate a caring response from healthcare professionals, thus co-creating safety in situ. Patients and relatives conduct risk work in order to diminish risks from mistakes and from damaging practitioner/patient relationships. The acute care context therefore affects the way that patient involvement in patient safety at the point of care is conceptualised, practised and understood. By explicating how vulnerability and dependency interact with risk and trust, and by applying the concept of risk work to patients, this thesis makes an original contribution to the study of patient involvement in patient safety.