King's College London, NIHR King's Patient Safety and Service Quality Research Centre, -2 Basement, Strand Bridge House, 138-142 Strand, London WC2R 1HH, United Kingdom.
Soc Sci Med. 2010 Aug;71(3):510-516. doi: 10.1016/j.socscimed.2010.03.050. Epub 2010 May 8.
Patient safety is a central issue in healthcare. In the United Kingdom, where there is more accurate information on National Health Service (NHS) hospitals than on primary care or the private sector, the evidence on adverse incidents shows that avoidable medical harm is a major concern. This paper looks at the occurrence of medical harm and argues that in the construction of patient safety reforms, it is important to be aware of alternative narratives about issues of power and accountability from harmed patients and self-help groups, that challenge dominant perspectives on the issues. The paper draws upon evidence from two sources. First, the paper draws on experiences of self-help groups set up as a result of medical harm and part of a campaigning network, where evidence was gathered from 14 groups over more than 2 years. In addition, data were obtained from 21 individuals affected by harm that attended a residential workshop called the Break Through Programme; 18 questionnaires were completed from participants and a written narrative account of their experiences and observational data were gathered from a range of workshop sessions. Looking at the issues from harmed patients' perspectives, the research illustrates that a model of medical harm focussing predominantly upon the clinical markers and individual agency associated with a medical model operates to obscure a range of social processes. These social processes, connected to the power and dominance of the medical profession and the activities of a wider state, are seen to be a major part of the construction of harm that impacts upon patients, which is further compounded by its concealment. Understanding the experiences of harmed patients is therefore seen as an important way of generating knowledge about the medical and social processes involved in harm, that can lead to a broader framework for addressing patient safety.
患者安全是医疗保健的核心问题。在英国，国民保健制度（NHS）医院的信息比初级保健或私营部门更准确，关于不良事件的证据表明，可避免的医疗伤害是一个主要问题。本文探讨了医疗伤害的发生，并认为在构建患者安全改革时，重要的是要意识到来自受害患者和自助团体的关于权力和责任问题的替代叙事，这些叙事挑战了对这些问题的主导观点。本文借鉴了两个来源的证据。首先，本文借鉴了由于医疗伤害而成立的自助团体的经验，这些团体是一个运动网络的一部分，在两年多的时间里从 14 个团体收集了证据。此外，还从 21 名因伤害而参加名为“突破计划”的住宿研讨会的个人那里获得了数据；18 份问卷是从参与者那里完成的，从一系列研讨会会议中收集了他们的经历和观察数据的书面叙述。从受害患者的角度来看待这些问题，研究表明，主要关注与医疗模式相关的临床标志物和个体机构的医疗伤害模型掩盖了一系列社会过程。这些与医疗专业人员的权力和主导地位以及更广泛的国家活动相关的社会过程，被视为伤害构建的重要组成部分，而伤害对患者的影响进一步加剧了其隐蔽性。因此，了解受害患者的经历被视为生成有关伤害所涉及的医疗和社会过程的知识的重要途径，这可以为解决患者安全问题提供更广泛的框架。
