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Contributed by

Helen Haskell, MA

President, Mothers Against Medical Error and Consumers Advancing Patient Safety

Co‐chair, WHO Patients for Patient Safety Advisory Group

Co‐chair, Patient Engagement, WHO Global Patient Safety Action Plan

National Steering Committee, Institute for Healthcare Improvement, National Action Plan on Patient Safety

Though people do not always recognize it, patient engagement lies at the heart of the modern patient safety movement. Stories of patient harm in the 1990s were the impetus for the early Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, and the patient stories on the opening pages of To Err Is Human were one of the main reasons that report resonated so profoundly with the public. Patient activism—the Picker Institute’s eight dimensions of care, distilled from years of patient interviews—underlay almost all the deliberations and recommendations of Crossing the Quality Chasm. These eight dimensions formed the basis for the STEEEP principles that still undergird our quality measurement framework.

More than two decades later, where do we stand? In some ways, patient engagement has been one of the big successes in patient safety and quality. The patient voice is increasingly prevalent throughout much of the health care system. We have patient and family advisory boards, family‐centered rounds, patient‐activated rapid response, shared decision‐making, and medical error disclosure programs. Crucially, we have patient surveys as a measure on which health care providers are assessed. Patient‐reported outcome measures are also now a part of many treatment programs.

Yet in many ways, patients have yet to be fully integrated as functional members of their own health care teams. System‐wide transparency and centralized, patient‐centered safety reporting systems, fundamental components of patient engagement, remain largely unfulfilled goals. Health equity is finally being recognized as a threat to safety and quality, but strategies to address it are only beginning to evolve. Effective ways of involving patients in the essential outpatient functions of diagnosis and medication safety are still being worked out. Two bright spots are the Institute for Healthcare Improvement’s Safer Together national action plan and the World Health Organization’s Global Patient Safety Action Plan, both of which propose to achieve these and other aims by creating broad learning systems with patient partnership at all levels. If we want to improve, this is the future of health care.