Up Front

New research aids efforts to ‘frame’ patient safety messages in more persuasive ways

Many of the ways in which professionals, advocates and mainstream media talk about patient safety today can be counterproductive, making it hard for others who know less about this work to grasp the meaning and importance of patient safety efforts.

That’s in large part because people in all walks of life hold deep-seated, cultural beliefs about human error, doctor-patient relationships, and the impersonal nature of systems — even those designed to keep patients safer. Those beliefs create static when the topic of patient safety is raised.

New social science research released this week by FrameWorks Institute and the Betsy Lehman Center delves deeply into those cultural belief systems and proposes more productive, tested ways to talk about medical error and patient safety with members of the general public as well as front-line health care professionals.

The report, “How to Talk about Patient Safety,” outlines useful ways to “frame” discussions about safety by tightly linking causes with proposed solutions, adopting a constructive rather than crisis tone about the prevalence of medical error and using metaphors that were helpful explainers of safety principles during extensive nationwide testing.

“Too few people understand what we mean by the term ‘patient safety,’ let alone the risks of preventable medical harm or the opportunities for reducing these risks,” says Barbara Fain, Executive Director of the Betsy Lehman Center, which initiated and collaborated on the research project. “FrameWorks’ research has identified new message ‘frames’ that we all can begin to use when we talk about safety to increase awareness and broaden the base of support for investment in improvement.” 

Define terms and ‘connect the dots’

The research suggests that when communicating about patient safety, organizations and advocates need to more explicitly define terms like “patient safety” and “medical errors,” as well as connect the dots between causes of errors and solutions. In addition:

  • Explain rather than assert the prevalence of medical errors. 
  • Adopt a constructive rather than a crisis tone.
  • Include the whole picture, rather than zooming in on one cause or solution. 
  • Use the aviation metaphor to explain how medical errors arise and how they can be reduced.
  • Use the fail-safe metaphor to help people grasp what solutions look like.

The social science approach used by FrameWorks is not intended to decipher what the public or health professionals want to hear about patient safety. Rather, it is intended to help those who talk about safety to bridge the gap between what experts understand about the topic and what non-experts need to know to be supportive of the need to place patient safety at the top of the health care improvement agenda.

"By better understanding the shared but implicit assumptions that inform the public’s and health care professionals’ thinking about patient safety, we can come up with more effective strategies for communicators to increase understanding and build support for solutions," says Rose Hendricks, Ph.D., the researcher at FrameWorks Institute who took the lead on the project.

For example, FrameWorks researchers found that while both the general public and health care professionals are suspicious of “systems” — preferring to think of their medical care in more human terms — they readily grasp that safety systems, such as pre-flight checklists, have made air travel in the U.S. demonstrably safer than it was decades ago.

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They also found that the term “fail-safe” is something recognizable and can be used as a short cut of sorts to describe needed safety protocols. For example, using two forms of patient identification are a “fail-safe” measure to ensure blood sample test results are matched to the right patient’s records.

Using safety advances in aviation as a metaphor for safety in health care settings — and using it in a new, medical care delivery will be beneficial.

The research also strongly suggests that patient safety experts and advocates explicitly define the terms “patient safety” and “medical error” whenever possible. Definitions should include two key features:

  • Emphasize that harm is preventable. Orienting people toward the possibility of prevention up front is important to avoid fatalism — the assumption that errors are inevitable. 
  • Definitions should include a range of concrete examples of medical errors to help people quickly grasp the nature of the problem. 

As a next step, the Betsy Lehman Center will work with organizations to develop a strategy for translating the research findings into actionable steps for all members of the patient safety community to use in their communications efforts.

“We look forward to working with our colleagues in Massachusetts and across the country,” Fain says. “The end goal is a health care system that keeps patients safe. This work will help us broaden the constituency of policymakers, health professionals and people for whom patient safety is always top of mind.”

Read the full report, “How to Talk about Patient Safety,” as well as the underlying research on our website.

Listen to a conversation about the research

What: How to make patient safety easier to explain and champion

Where: The Institute for Healthcare Improvement's WIHI podcast

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