Safety of patients in primary health care


The safety of patients in primary health care setting has mostly been explored in the
context of eliminating medical error. This often leaves out important factors that patients
find pertinent to their safety as established in the article “Sensemaking and the co-

production of safety: a qualitative study of primary medical care patients” by Rhodes et
al. (2016). The research by Rhodes et al. (2016) explores how primary care patients
make sense of safety and co-produce safety, concluding that there is need for a broad
conceptualisation of patient safety, in order to address patients’ concern on safety in
primary care settings. This essay is a critical analysis of the article by Rhodes et al.
(2016) to evaluate its research problem and significance, methodology used, findings
and their significance in contemporary nursing policy and practice.

Research problem and significance

The research problem as presented by Rhodes et al. (2016) is the safety of
patients, with specific interest in the manner in which patients perceive and define
safety, and how they make sense of their experiences in primary care settings. The
patient perspective of safety presents a contemporary issue that is of considerable
medical research interest, having been previously studied by among others Rhodes, et
al. (2014), Baran et al (2011), Ricci-Cabello et al. (2016) and Daker-White, et al. (2015).
All these studies seek to understand patients’ understanding of safety and how it can
inform the medical profession, given that a majority of previous studies mostly focused
on medical safety. Based on this, it can be established that Rhodes et al. (2016) take on
an important research problem that is bound to provide viable solutions in patient safety.

The significance of the article by Rhodes et al. (2016) is that it addresses an
important aspect of medical care (safety) and introduces the relevance of sensemaking
in understanding the perception of patients on safety. Authors have justified the
significance of their study as it helps in the identification of factors that influence

patients’ sense of security, such that this can be addressed to ensure quality services
are provided in healthcare settings. This resonates well with the research by Rhodes,
Campbell and Sanders (2016), which establishes that patients envision safety in
completely different ways than what has been documented. Daker-White et al. (2015) in
their research offer similar sentiments but also discuss factors related to the patient
including attendance errors, misjudgments, memory limitations, emotional factors and
patient preferences that may impact on patient safety.

Research design and methods

This research utilizes the qualitative design in determining the sensemaking and
safety co-production. Qualitative research denotes a design in which researchers aim at
understanding phenomena by interacting with the population’s views and lived
experiences (Yin, 2013). In obtaining data for the research, the interview method was
utilized for the study. This was done through interviews among selected respondents,
mostly in their homes. Quimby (2012) notes that interviews are effective in the collection
of data because they allow the researcher to obtain more complete and authentic data.

The researchers make deliberate attempts at improving the reliability and validity of
their research. Being a human subject research, it is commendable that the researchers
sought ethical approval before beginning their research (Yin, 2013). An important
aspect in conducting research is avoiding bias by ensuring that the study sample
selected is representative of the population (Quimby, 2012). The researchers
endeavored to ensure maximum variability in terms of age, career status, education
level, socioeconomic level, and ethnic background. The study also included a wide age

consideration, with respondents being aged between 18 and 78 years. However, it is
notable that the method used in selecting the sample may not have been appropriate in
ensuring equal representation. Being a form of purposive sampling, maximum variation
sampling may lead to bias because it selects respondents based on the researcher’s
convenience, which in this case led to a deliberate over-sampling of patients with long-
term conditions. Snowballing may give rise to bias, given that the recruitment of
respondents is based on referrals from the first batch of respondents (Yin, 2013).
Despite attempting to show demographic variability, the authors do not break down the
composition of the sample.

The data collected was analyzed using a qualitative data analysis software
(NVivo10). The analysis involved thematic and iterative techniques, targeted at
generating open codes. Some initial themes were identified through a coding system,
and these were later distilled into three core themes. For sensemaking purposes, the
data was reanalyzed using Weick’s framework.

Findings and their relevance to contemporary nursing policy and practice

The findings of this study are presented under three broad areas. The first is
Sensemaking and the articulation of safety, whereby the authors discuss patient
responses on their understanding of medical safety. The authors note that most
respondents closely associate safety with the quality of care received and
professionalism of the care provider. Further, participants reported the importance of
both psychosocial and physical aspects of safety in primary care (Rhodes, Campbell &

Sanders, 2016). These aspects of safety emerge in other studies such as Rhodes,
Campbell and Sanders (2016) and Ulrich and Kear (2014).

The second area is sensemaking from experience: reflecting on safety and practice,
where narration by patients identified the specific situations which made them feel
unsafe including practitioner attitudes, doctor interpersonal skills, technical competence
and the possibility of getting the same medical personnel for consecutive consultations.
Results from Rhodes, et al. (2014) also indicate similar safety issues, where
patient–doctor continuity is considered important in promoting patient safety. Ricci-
Cabello et al. (2016) also identifies health professional behavior and attitudes and
physical environment as factors influencing safety.

The third area is Proactive patients and the co-production of safety, where results
indicated that patients can contribute to their own safety through proactive measures
such as using their knowledge and previous experiences to safeguard against risk.
Through understanding their conditions, obtaining information on treatment options,
challenging practitioner procedures or decisions, patients were able to avoid risk. The
study by Mehra (2015) alludes to this, based on its findings that information-seeking
behavior among patients can play a vital role in promoting quality of health care.

The findings of this research have various implications for the nursing practice. The
nursing practice needs to open up to the possibilities of more safety dimensions
affecting patients such as physical, architectural, psychological and moral safety
dimensions identified by Rhodes et al. (2016). Policy would need to go beyond the
functional impairment that the health sector focuses on currently. Burgess et al. (2012)

emphasizes on the need to expand beyond the ‘error risk’, by integrating newly
discovered safety aspects including psychological and emotional harm. Rhodes et al.
(2014) discover similar findings, establishing that psychological safety factors are
important patient perspectives that should be considered in the medical profession. This
is accentuated by Ricci-Cabello et al. (2016) who notes that current frameworks on
patient safety are solely based on professional and healthcare system perspectives.


This essay provides a critical analysis of the article Sensemaking and the co-
production of safety: a qualitative study of primary medical care patients’ by Rhodes et
al. (2016). This analysis has evaluated the problem statement, noting that the study
investigates patient safety from a patient perspective through a sensemaking
framework. The authors utilize a qualitative study approach, involving the use of semi-
structured interview to collect responses form a total of 38 respondents. The study
presents important findings for nursing, such as the close association between safety
and quality in patient’s interpretation of safety.


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