Emotional safety is patient safety

Correspondence to Dr Audrey Lyndon, Rory Meyers College of Nursing, New York University, New York, NY 10010, USA; [email protected]

A growing body of research on patients’ and families’ understanding and conceptualisation of patient safety^{1 2} begs the question of how and why we, in healthcare and the field of patient safety and quality, conceptualise patient safety as a domain separate from patient-centredness and patient experience.³ In this issue, Archer et al contribute to this body of work.⁴ The authors explored patients’ conceptualisation of safety across three UK teaching hospital inpatient specialty wards in a qualitative interview study with a purposive sample of 24 English-speaking patients, 8 each from gerontology (medicine for the elderly), elective surgery and maternity (postnatal) wards. The authors found that patients in their study conceptualise safety as ‘feeling safe’ rather than ‘being safe’, and present a model of actions (performed, received, shared and observed) at the levels of self (patient), staff, family and friends, and the organisation that contribute to patients’ ‘feeling safe’. The study findings are consistent with prior studies indicating patients conceptualise safety differently from clinicians and that from the patients’ and families’ perspective; ‘patient experience’ and ‘patient safety’ are fundamentally intertwined.^5–7 Archer et al argue for the development of a new multistakeholder paradigm to include a deep understanding of ‘what matters to patients to feel safe in hospital’, that is, ‘feeling safe’; yet they maintain a distinction between ‘feeling safe’ and ‘being safe,’ where only ‘being safe’ is characterised by minimising the risk of patient harm.

We fully endorse the need for changing the paradigm in patient safety. We endorse this need from our positions as patient safety and quality experts, as researchers, as health workers and as consumers—meaning as patients, as loved ones and as caregivers of people receiving medical treatment who have experienced disrespect, dismissal, medical racism,⁸ near-misses and patient harm. However, we argue that limiting the conceptualisation of the patient’s perspective on safety as ‘feeling safe’ while maintaining a distinction between ‘feeling safe’ and ‘being safe’—which remains the norm in most patient safety and quality programmes—presents several problems. First, the differentiation between ‘feeling safe’, as defined through patient experience, and ‘being safe’, as defined through observation and evaluation using clinical...