Defining Patient Harm & Its Impact on the Patient Experience

What Is Patient Harm?

Patient harm is not the same as adverse patient safety events. While patient safety events entail the process failure that creates a hazardous situation for the patient, patient harm refers to the effect of that event.

Patient harm is “any physical or psychological injury or damage to the health of a person, including both temporary and permanent injury,” according to a National Quality Forum glossary of patient safety terms.

For example, a fall in the hospital is an adverse patient safety event; the physical pain resulting from that fall, plus any worries or fears about falling again, is patient harm.

Indeed, that psychological impact is a critical type of patient harm. While patient harm can certainly be the physical impact of a process error, many organizations home in on the psychological impacts as well. Experiencing an adverse patient safety event, a process error, or a breakdown in care team communication can instill fear in the patient.

That fear, and any other psychological impacts of adverse events, are just as critical as the event itself.

How Does Patient Harm Affect Patient Experience?

The concept of patient harm is innate to the patient experience. Because patient harm is the byproduct of an adverse safety event, it is fitting that it is linked to the patient perception and experience of care. Put simply, when a patient safety event results in patient harm, the patient did not have a good experience.

That tracks out with the data. The spring 2023 Hospital Patient Safety Grades from patient safety advocates The Leapfrog Group showed a concurrent uptick in adverse events and downswing in patient experience. That’s because the harms resulting from adverse events negatively impacted the experience.

For some experts, creating a good patient experience is about reducing patient harm. While patients may report good rapport with their providers or laud the cleanliness of the hospital environment, those factors will not matter if the patient experiences harm.

Moreover, it is essential to consider patient perceptions of safety and reduced harm.

Patient experience consultant Press Ganey points out that perceived safety is not the same as adhering to clinical guidelines. Input from patient and family advisory councils may help organizations identify strategies to support patient perceptions of safety—of course, in addition to actual safety—while patient surveys can also illuminate these areas.

Ways to Mitigate Patient Harm

In addition to the clinical practice necessary to help patients physically recover from a patient safety event, it is important for providers to be transparent about the issue. Hospitals and the clinicians who work in them should be honest with patients when a patient safety issue has occurred.

According to the American Medical Association, transparency about patient harms should encompass four key steps:

• Explain: outlining what error occurred and why
• Apologize: apologies should happen when appropriate, AMA stresses
• Communicate: providers should explain how they will address the physical health impacts of the mistake as well as any long-term consequences of the adverse event
• Prevent: address how the provider and care team will work to prevent similar events from happening again

It should be noted that offering an apology following an adverse patient safety event can be a hospital liability issue. Clinicians should discuss the protocol for apologizing with organizational leadership to ensure they are adhering to best practices.

That said, it is important for healthcare providers to be able to apologize when a patient harm has occurred. An apology can be an important step in rectifying the issue and, in fact, reducing patient harm, but it doesn’t come naturally to a lot of providers. In 2016, researchers wrote in BMJ Quality and Safety that most providers would offer no or a limited apology when a medical error has occurred.

The odds of offering a full apology increased when the clinician perceived more personal responsibility or the medical error resulted in considerable patient harm.

The Institute for Healthcare Improvement (IHI) recommends healthcare providers work to get four elements into their apologies to patients. Providers should acknowledge the harm incurred, explain how it happened, express remorse and humility, and offer reparations for what happened. It is also helpful to speak in factual terms.

IHI also advises providers to bring an administrator to help explain the non-clinical issues at play and a social worker or hospital chaplain to offer emotional support to patients.

Of course, admitting wrongdoing is a difficult thing for anyone to do. As more organizations adopt a culture of patient safety, they are emphasizing a non-punitive system for reporting patient safety events. Patient safety events are usually the result of a process error in the hospital, so reporting them is a good step toward quality improvement.

And a commitment to improvement, plus acknowledging a mistake, as a good step toward reducing patient harm.