title: Sensemaking and the co-production of safety: a qualitative study of primary medical care patients.
abstract: This study explores the ways in which patients make sense of 'safety' in the context of primary medical care. Drawing on qualitative interviews with primary care patients, we reveal patients' conceptualisation of safety as fluid, contingent, multi-dimensional, and negotiated. Participant accounts drew attention to a largely invisible and inaccessible (but taken for granted) architecture of safety, the importance of psycho-social as well as physical dimensions and the interactions between them, informal strategies for negotiating safety, and the moral dimension of safety. Participants reported being proactive in taking action to protect themselves from potential harm. The somewhat routinised and predictable nature of the primary medical care consultation, which is very different from 'one off' inpatient spells, meant that patients were not passive recipients of care. Instead they had a stock of accumulated knowledge and experience to inform their actions. In addition to highlighting the differences and similarities between hospital and primary care settings, the study suggests that a broad conceptualisation of patient safety is required, which encompasses the safety concerns of patients in primary care settings.
authors.affiliation: NIHR School for Primary Care Research, University of Manchester.
authors.forename: Penny
authors.initials: P
authors.lastname: Rhodes
authors.affiliation: Manchester Business School and NIHR School for Primary Care Research, University of Manchester.
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.affiliation: NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), NIHR School for Primary Care Research, University of Manchester & Research and Action in Public Health (CeRAPH), University of Canberra.
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.affiliation: NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), University of Manchester.
authors.forename: Gavin
authors.initials: G
authors.lastname: Daker-White
authors.affiliation: NIHR School for Primary Care Research & Manchester Academic Health Sciences Centre (MAHSC), University of Manchester.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
mesh_terms: D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000523:psychology; D002983:Clinical Competence; D004777:Environment; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D061214:Patient Safety; D010361:Patients / Q000523:psychology*; D010465:Perception; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012962:Sociology, Medical
keywords: primary care; quality of care; safety