title: Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study.
abstract: BACKGROUND
  Patient safety research has tended to focus on hospital settings, although most clinical encounters occur in primary care, and to emphasize practitioner errors, rather than patients' own understandings of safety.
  
  
  OBJECTIVE
  To explore patients' understandings of safety in primary care.
  
  
  METHODS
  Qualitative interviews were conducted with patients recruited from general practices in northwest England. Participants were asked basic socio-demographic information; thereafter, topics were largely introduced by interviewees themselves. Transcripts were coded and analysed using NVivo10 (qualitative data software), following a process of constant comparison.
  
  
  RESULTS
  Thirty-eight people (14 men, 24 women) from 19 general practices in rural, small town and city locations were interviewed. Many of their concerns (about access, length of consultation, relationship continuity) have been discussed in terms of quality, but, in the interviews, were raised as matters of safety. Three broad themes were identified: (i) trust and psycho-social aspects of professional-patient relationships; (ii) choice, continuity, access, and the temporal underpinnings of safety; and (iii) organizational and systems-level tensions constraining safety.
  
  
  CONCLUSIONS
  Conceptualizations of safety included common reliance on a bureaucratic framework of accreditation, accountability, procedural rules and regulation, but were also individual and context-dependent. For patients, safety is not just a property of systems, but personal and contingent and is realized in the interaction between doctor and patient. However, it is the systems approach that has dominated safety thinking, and patients' individualistic and relational conceptualizations are poorly accommodated within current service organization.
authors: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK.
authors: Penny
authors: P
authors: Rhodes
authors: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK.
authors: Stephen
authors: S
authors: Campbell
authors: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors: Caroline
authors: C
authors: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D004739:England; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D035502:Trust
keywords: general practice; patient safety; patients' perceptions; primary care; systems; trust
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