The active patient: Voicing and correcting behaviors by patients and families to ensure safety in healthcare organizations

• This study explores how patients and families ensure treatment safety in hospital. • It finds them to prevent safety incidents through voicing and correcting behaviors. • These behaviors ensure that safety issues missed or ignored by hospitals are fixed. • Yet staff sometimes rebuff ‘active patients’, and thus lose opportunities to avert harm. • The study shows how non-employees can be a key influence on safety in organizations. Healthcare research increasingly observes that patients and families can be highly active in trying to prevent medical accidents. However, the safety literature lacks a model of these behaviors. Addressing this gap would not only advance understanding on how patients and families contribute to healthcare safety, but also provide a general framework for studying how non-employee stakeholders such as citizens and service-users influence safety outcomes in other organizational contexts. Therefore, the current study aimed to establish a model of the behaviors used by patients and families to prevent accidents and ensure safety whilst in hospital. Using a mixed qualitative-quantitative research design, we analyzed 1,857 healthcare complaints submitted by patients and families to UK hospitals reporting poor treatment experiences. Our analysis focused upon reports within the complaints of healthcare users engaging in (1) voicing behaviors to raise concerns about safety with staff and (2) correcting behaviors to directly resolve safety issues. Approximately three quarters of complaints reported patients and families having engaged in voicing and correcting behaviors, with them often doing so to ensure the resolution of missed and emerging safety problems. The behaviors contributed to hospital safety outcomes through helping staff to spot and resolve errors and hazards, intervening to ensure that safety standards were maintained, and bypassing teams and hospitals when they were judged as too unsafe. The study adds to the literature by establishing a framework for studying how the behaviors of non-employee stakeholders in healthcare and other domains contribute to organisational safety.