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J Eval Clin Pract. 2013 Oct;19(5):840-8. doi: 10.1111/j.1365-2753.2012.01861.x. Epub 2012 May 29.

A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention.

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Scientific Head, Swiss Patient Safety Foundation, Zurich, Switzerland and Professor of Patient Safety, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland Project Manager, Swiss Patient Safety Foundation, Zurich, Switzerland Research Associate, Imperial College London, Department of Surgery and Cancer, London, UK.



Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours.


To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error.


Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient.


Twelve hospitals in Switzerland.


A total of 1141 HCPs (response rate 45%).


Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient-HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales.


Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient-HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation.


This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues.


factorial survey; medical errors; patient safety; vignettes

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