This year, World Patient Safety Day took place on 17 September, with the theme ‘improving diagnosis for patient safety’. Chloe Shields, IQAS and QPIDS programme coordinator, highlights the role of lay assessors and patient representatives in improving diagnosis for patients in her interview below: 

Within the Accreditation Unit (AU) at the RCP, we host and deliver several accreditation programmes, two of which are our Quality in Primary Immunodeficiency Services (QPIDS) and Improving Quality in Allergy Services (IQAS). Accreditation is patient-centred – it aims to improve the quality of care provided to patients by measuring clinical services against national standards and encouraging continual quality improvement. Accreditation follows a robust assessment pathway where lay representation is a vital and integral part of an assessment team.  

I had the honour of talking to Mr Jeffrey Goodwin, one of our lay assessors within the AU, who is also our QPIDS patient representative. We explored how accreditation supports the improvement of patient diagnosis, ultimately improving patient safety.  

Could you briefly explain your role as lay assessor in accreditation? 

My role in the assessor team is to represent the patient, so whilst reviewing the evidence that has been submitted by a service, there are certain aspects I will focus on within my review. Once we have reviewed all of the evidence and discussed it as a team, I then take the opportunity to interview a group of patients from that service to discuss their experiences.  

I will interview five to ten patients, and I will then use that to write a report that I provide to the rest of the assessment team to discuss any areas that could deserve congratulations or that should be an area of concern.  

From your perspective as the patient representative, what steps do you think patients can take to feel more empowered and informed during the diagnostic phase of their care? 

I have four aspects that I consider important – patient respect, communication, patient safety, and how the service is reviewing/evaluating things when they go wrong. When looking at patient respect, I look at the relationship which the service builds up with patients, looking at how consultants and nurses treat patients with dignity and privacy, and aspects like this. I check how the patients are involved in decision making and will ask questions directly to the patient to ensure that they fully understand any documents they have been given and have a full understanding of their condition. 

I will look at how the service address ethnic and cultural differences to make sure that the patient is comfortable with who they are talking to within a service, and how the service would link in with the patient and their families so that everyone who needs to be involved with decision making is a part of the journey. Communication is key for consultants and nurses as they need to explain to patients what is happening; this is important because if the patient does not understand what they are being told this can sometimes cause anxiety. Some examples of questions that I might ask: Does the patient understand what they are being told? Is the service communicating with other consultants and keeping the GP informed? Without communication, it can be unsafe as a consultant could be unaware of what has been diagnosed somewhere else.  

I will then look into physical patient safety and, if the environment is safe and the patient is okay, where they may do treatment or further investigations. Has the service asked the patients' point of view, if it works for them and if they feel safe in their environment? Lastly, how is the service reviewing and evaluating things when they go wrong? What procedures do they have for evaluating things and how do they then address this and deal with the situation? I like to think from the patient's perspective and if they have really understood what to expect when visiting the hospital. Did they get a good letter? Was it easy to find the place? Could they find a toilet? Even though these seem like little things to ask, they are important because even though they are not directly related to diagnosis, it sets the scene so that the patient is at ease. 

Through being a part of the accreditation process, how have you seen services ensure their patients are empowered and informed throughout? 

When I come to do a reaccreditation or new accreditation, we get the notes and look at how they have been progressing; I look and see if there are any things that don’t seem to be changing – this is rarely an issue that I find. I spend longer looking at the evidence the service provides than I do interviewing the patients; it can take me 1–2 days to do an evidence review. Sometimes I ask for more information, or I will work with the other assessors and ask where the evidence came from and when they actioned the evidence. Sometimes an out-of-date piece of evidence can be provided so it's flagging this up to make sure we have all the correct evidence provided. All the work done behind the scenes reviewing the evidence helps the service update their documents to help patients stay informed, and through helping patients stay informed they will feel empowered with their journey in hospital.  

I recently did a reaccreditation where the premises were not suitable and, through using the accreditation process, the hospital team were able to bring this issue up to directors and receive help to make changes within the service. Because we were able to flag this up, the service can now make changes that help patients who may regularly need to use the hospital. 

As a patient representative, what changes have you seen so far in the health care system to improve diagnostic safety? What changes would you like to see?  

I think the main thing that I would say is the way patients are more involved in the process. Some hospitals do a ‘patient knows best’ project and it takes the patients viewpoint into account. I think over time I have noticed there is more of an emphasis on what the patients think, the quality of the sort of feedback and how that is reported back. For example, ‘You said. We did’ posters have started to appear around hospitals and it's an effective way to communicate back to patients and staff about what has been done. I think that privacy, dignity and respect have all had more attention; although there was a focus on them before they have now started involving patients in decision making so it's highlighted a lot more now. 

There is nothing in particular that I would like to see changed, I think focusing a bit more on evaluating the environment, like the equipment and facilities. Seeing more involvement with patient focus groups would be great. I think that all hospitals should have patient-led groups for ongoing change and improvement. Having patient representatives within all steering groups would be good because then we are able to feed information from people outside into the entire process and this can help the patient experience, and I think that it would be great to link this to diagnosis and safety. 

Once a service has been accredited, how do you think it benefits patients and contributes to their safety?  

Accreditation means you have met a set of standards, and it is a review of the service you provide to your patients. You are reviewing against something which is tangible, and you can look at it and say you might not be meeting this aspect, or you are definitely meeting this aspect. It is felt that everything in the service meets a certain standard. It gives us an overview and we can notice any issues where they might need extra attention, so any kind of evaluation a service has is good for improving things for patients, especially safety. 

I think after an accreditation process has happened and the report goes to the service, the next step is the service reflecting on what has been said and what points could change or have little improvements here and there. These changes help the service to build and develop things that will make it better for patients and make it safer for things like diagnosis, treatment and facilities. Something as simple as a letter and updating the information to make it easier for a patient to understand and read is a big step towards a positive change.  

Reflecting on these points, this is why accreditation is important for services and there is an ongoing cycle of improvement.