Patients’ and carers’ views and their involvement in safety in Australian primary care

Author: Andrea Hernan

Hernan, Andrea, 2018 Patients’ and carers’ views and their involvement in safety in Australian primary care, Flinders University, College of Medicine and Public Health

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Primary care is the first point of contact for most people entering the health system and most patient journeys begin and end in primary care. While the extent of safety incidents are unknown for a range of reasons, error rates in primary care are likely to be significant.

Patients are valuable sources of information about ways to prevent safety incidents. Evidence from secondary care settings suggests patients and carers are willing and able to provide feedback on the safety of healthcare and can identify a range of error producing and latent conditions which contribute to safety incidents. Patients’ views and potential involvement in patient safety in primary care is an under researched area, particularly in Australia.

The aim of this thesis was to investigate patients’ views of safety in Australian primary care and to develop a tool which captures these views of safety in order to facilitate practice safety improvement. This thesis includes three peer reviewed manuscripts which address this aim.

The research undertaken during this thesis occurred in three phases. Phase 1 explored patients’ and carers’ experiences of primary care and their perceptions of safety. Four focus groups were conducted with n=26 patients and carers from the Greater Green Triangle (GGT) region of south east Australia. Patients generally had an assumed sense of safety which was mediated by the trusting and the continual nature of the doctor-patient relationship. These factors impacted on patients’ perceptions of overall risk in primary care. These results suggested a need to further explore what latent and error producing conditions in the primary care environment patients can identify that may contribute to safety incidents.

Phase 2 explored the contributing factors to safety incidents that patients and carers can identify in primary care. Qualitative data from Phase 1 was combined with n=8 semi-structured interviews with patients, carers and consumers from the GGT region. Thirteen factors that contribute to safety incidents in primary care were identified by participants. Phases 1 and 2 findings provided the evidence for developing a tool that systematically captures the multiple contributory factors to patient safety from the patients’ perspective.

Phase 3 developed and tested the face validity of a primary care patient measure of safety (PC PMOS) tool. A modified Delphi methodology was employed to develop the domain and items of the questionnaire. Face validity testing occurred with both patients (n=11) and primary care staff (n=9). The PC PMOS consists of 50 items covering 15 contributory factor domains. These factors include but are not limited to communication, access to care, patient related factors, organisation and care planning, task performance and information flow.

In conclusion, this thesis demonstrates that patients are willing and able to provide feedback on factors that contribute to safety incidents in primary care. Patient feedback captured on the PC PMOS tool could help primary care professionals, organisations and policy makers better understand and identify potential safety concerns and make appropriate service improvements and policy changes with the aim of reducing incidents in this setting.

Keywords: patient safety, contributory factors to safety incidents, primary health care, general practice, patient involvement in safety, patient perspectives of safety, patient feedback, patient measure of safety, survey, questionniare, qualitative research

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Medicine and Public Health
Supervisor: Associate Professor Vincent Versace