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BACKGROUND: One in 10 patients admitted to hospital will suffer an adverse event as a result of their medical treatment. A reduction in adverse events could happen if patients could be engaged successfully in monitoring their care. OBJECTIVES: This study explored: (1) surgical patients' willingness to question healthcare staff about their treatment; (2) differences between patients' willingness to ask factual vs. challenging questions related to the quality and safety of their healthcare; (3) patient demographic characteristics that could affect patients' willingness to ask questions; and (4) the impact of doctors' instructions on patients' willingness to ask questions. DESIGN: Cross-sectional study using the Patient Willingness to Ask Safety Questions Survey (PWASQS). The PWASQS questions were devised in accordance with current patient safety initiatives aimed at encouraging patients to ask healthcare staff specific safety-related questions about their healthcare. The PWASQS includes factual questions (eg, "when can I return to my normal activities?") and challenging questions (eg, "have you washed your hands?"), and examines the impact of doctors' instructions on patients' willingness to ask challenging questions (eg, if instructed to by a doctor would you be willing to ask: "have you washed your hands?"). Data were analysed using non-parametric tests. SETTING: An inner-city London teaching hospital. PARTICIPANTS: A convenience sample of 80 patients who had undergone surgery. FINDINGS: Surgical patients were significantly more willing to ask: doctors factual versus challenging questions (z = 7.59, p<0.001); nurses factual versus challenging questions (z = 5.39, p<0.001); doctors versus nurses factual questions (z = 4.98, p<0.001); and, nurses versus doctors challenging questions (z = 4.40, p<0.001). Doctor's instructions to the patient increased patient willingness to challenge doctors (z = 6.56, p<0.001) and nurses (z = 6.15, p<0.001).Women, educated patients, and patients in employment, were more willing to ask questions (p<0.05). CONCLUSION: Surgical patients, particularly those who are men, less educated or unemployed are less willing to challenge healthcare staff regarding their care than to ask healthcare staff factual questions. Patient involvement strategies which take into account patient characteristics need to be developed for patients and staff in order to encourage patient involvement in this much neglected area.

Original publication




Journal article


Qual Saf Health Care

Publication Date





90 - 96


Attitude to Health, Cross-Sectional Studies, Educational Status, Employment, Female, Hospitals, Teaching, Humans, London, Male, Medical Staff, Professional-Patient Relations, Quality of Health Care, Safety Management, Sex Factors, Surgical Procedures, Operative, Surveys and Questionnaires