Elective surgery patients and safety: making sense of the hospitalisation experience

Professor Mark Saunders

What questions arise from patients about their safety as they prepare for, and recover from, elective surgery?

The quality of hospital patient care and ensuring their safe treatment has been front-page news in the UK, with reports highlighting the need for improvement. Insights on this have been offered by a Surrey Business School qualitative study of 38 elective surgery patients during a 3 March seminar — co-authored by WOW/ Griffith Business School visitor, Professor Mark Saunders, and colleague, Dr Carole Doherty — which sought to understand just how patients make sense of their hospitalisation experiences (both pre- and post-operation), and how that sense making informs ideas around their safety.

Although any focus on safety usually centres around, and is measured by, compliance to rules, this study has revealed how interviewees position the UK’s National Health Service (NHS) as a mythologised, benevolent healthcare provider where doctors are the experts, nurses are angels, and medical science provides the answer to their health woes.

With interviews taking place at three stages in the hospitalisation stay — pre-operation, at the consultation phase; and post-operation on the ward, then six weeks following discharge — patients’ stories focussed primarily on what was happening to them and how they felt.

In bringing together the responses, the research team have identified three pertinent sense making themes. Firstly, in the patient-clinician relationship, interviewees took on a subordinate role — a combination of passive receipt about the situation of their health and an acknowledgment of the technical expertise held by those treating them.

Second, through a lens which considered the emotional and morale role of the NHS — Europe’s largest employer — patients also navigated a paradoxical position of trust and doubt. Informed by their own experiences as healthcare professionals, Mark – a former social care research officer – and Carole – a former nurse and nurse manager, utilised interviewees’ stories to also highlight the role that presumptive trust played in patients’ sense making:

“Patients presume that they will be treated well by the best qualified and most competent of clinicians. However this trust does not [initially] come from patients’ interactions with healthcare professionals. It instead comes from a pre-formed, almost mythologised, belief of the healthcare service and the doctors and nurses”, explains Mark.

Although the clinician stills plays a role, Professor Saunders clarifies that: “[They are] held in a certain esteem for having expertise and an integrity that positions them as the ‘trustee’ of patients’ safety. What this does though is create a relationship of passive dependency for the patient.”

The third theme to emerge highlighted the most negative of patients’ sense making outcomes. The chaos, suffering and search for meaning found during both of the post-operation stages under consideration revealed a clear patient perception of their trust having been violated. While a myriad of factors are reported to have contributed to this — the unusual physical and psychological state that illness puts one in, mis-managed/ -interpreted clinician bedside manner etc., patients still placed trust in the technical expertise of the healthcare provider as they played a game of self-blame and disempowerment to rationalise their hospitalisation experience.

As the research team seek to encourage both healthcare providers and patients to take joint responsibility for safety by facilitating a more informed two-way dialogue during hospitalisation, Professor Saunders and Dr Doherty have also recognised the potential negative implications that the unrecognised and undocumented psychological harm of a hospital stay, and the need to maintain trust in clinicians as matters of safety are addressed, has.

This research was published in the December 2013 issue of the journal of Social Science and Medicine (volume 98).