title: Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.
abstract: OBJECTIVE
  Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.
  
  
  METHODS
  Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.
  
  
  RESULTS
  Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.
  
  
  CONCLUSIONS
  Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.
authors.affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Gavin
authors.initials: G
authors.lastname: Daker-White
authors.affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hays
authors.affiliation: Department of Psychology, National University of Ireland (NUI) Galway, Galway, Ireland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McSharry
authors.affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Giles
authors.affiliation: National Institute for Health Research (NIHR), Greater Manchester Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Sudeh
authors.initials: S
authors.lastname: Cheraghi-Sohi
authors.affiliation: NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Penny
authors.initials: P
authors.lastname: Rhodes
authors.affiliation: NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D006801:Humans; D061214:Patient Safety; D011320:Primary Health Care / Q000379:methods; D011369:Professional-Patient Relations