Kooijman Allison, Canfield Carolyn
University of British Columbia, Okanagan Campus, Kelowna, BC, Canada.
University of British Columbia, Vancouver, BC, Canada.
Front Health Serv. 2024 Dec 9;4:1471183. doi: 10.3389/frhs.2024.1471183. eCollection 2024.
This perspective article shares the viewpoints of two long-standing patient safety advocates who have participated first-hand in the evolution of patient engagement in healthcare quality and safety. Their involvement is motivated by a rejection of the common cruelty of institutional betrayal that compounds harm when patient safety fails. The advocates have sought to understand how it can be that fractured trust spreads so predictably after harm, just when it most needs strengthening. Instead, the abandonment of trust upends healthcare values and effectiveness at interpersonal, systemic and structural levels. They argue that authentic care (healthcare that is truly caring) transcends mere service delivery, thus embodying an inviolable commitment to mutual well-being, compassion and generosity. The advocates identify the influence of social determinants, such as culture, identity, and socioeconomic status, as critical to trust formation, where pathogenic vulnerability exacerbates existing inequalities and further impedes trust. The advocates call for a shift from transactional to relational, trust-based interactions that explore the potential for mobilizing restorative justice principles to repair harm and rebuild trust, enabling dialogue, mutual understanding and systemic improvement. Trust, they assert, is born in relationships, not transactions. The bureaucratic, legal and resource constraints that often impair meaningful interactions, also cause moral distress to healthcare providers and poor care quality for patients. They argue that central to the current healthcare crisis is the fundamental need for genuine connection and trust, framing this as both a practical necessity and a confirmation of humanity as intrinsic to healthcare. The advocates envision a future where patient engagement is integral to patient safety to prioritize epistemic justice, mutual respect and compassionate care, to restore healthcare as a cohesive, supportive and deeply human endeavor. They query what contributions a restorative approach could make to centre trust as necessary for cultivating the conditions for care in our healthcare system.
这篇观点文章分享了两位长期致力于患者安全的倡导者的观点，他们亲身参与了患者在医疗质量和安全方面参与度的演变。他们的参与源于对机构背叛这种常见残酷行为的抵制，当患者安全出现问题时，这种背叛会加剧伤害。倡导者们试图理解，为何在伤害发生后，信任破裂会如此可预测地蔓延，而此时恰恰最需要加强信任。相反，信任的缺失在人际、系统和结构层面颠覆了医疗价值观和有效性。他们认为，真正的关怀（即真正具有关怀性的医疗）超越了单纯的服务提供，体现了对共同福祉、同情和慷慨的不可侵犯的承诺。倡导者们指出，社会决定因素，如文化、身份和社会经济地位，对信任的形成至关重要，其中致病的脆弱性会加剧现有的不平等并进一步阻碍信任。倡导者们呼吁从基于交易的互动转向基于关系和信任的互动，探索运用恢复性司法原则修复伤害和重建信任的可能性，促进对话、相互理解和系统改进。他们断言，信任产生于关系之中，而非交易之中。那些常常损害有意义互动的官僚、法律和资源限制，也给医疗服务提供者带来道德困扰，并导致患者护理质量低下。他们认为，当前医疗危机的核心是对真正联系和信任的根本需求，将其视为一种实际必要条件，也是对医疗中人性本质的一种确认。倡导者们设想了一个未来，在这个未来中，患者参与对于患者安全至关重要，以优先考虑认知公正、相互尊重和关怀护理，将医疗恢复为一项凝聚、支持且极具人性的事业。他们质疑恢复性方法能做出哪些贡献，以将信任作为在我们的医疗系统中培育护理条件的必要核心。
