ArticlePloS one2015
Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
55 citing papers in PubMed, 6 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Older Patients' Verbal Communication in Interactions With Primary Care Staff: A Qualitative Systematic Review and Meta-Ethnography.Health expectations : an international journal of public participation in health care and health policy · 2025Pooled it
- Patient and family engagement interventions in primary care patient safety: systematic review and meta-analysis of randomised controlled trials.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Pooled it
- Patient Safety Domains in Primary Healthcare: A Systematic Review.Ethiopian journal of health sciences · 2024Pooled it
- Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review.Journal of pharmacy practice · 2023Pooled it
- The views and experiences of patients and health-care professionals on the disclosure of adverse events: A systematic review and qualitative meta-ethnographic synthesis.Health expectations : an international journal of public participation in health care and health policy · 2020Pooled it
- Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity.BMC family practice · 2015Pooled it
- Specialist Rehabilitation Providers' Experiences With an Online Self-Compassion Course: Reflexive Thematic Analysis.JMIR rehabilitation and assistive technologies · 2026Article
- The impact of inpatient medication administration technologies on nursing autonomy and practice: a meta-ethnographic synthesis of the qualitative literature.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Developing a medication-safety self-assessment tool for rural primary care units - a case from Finnish Lapland.BMC primary care · 2025Article
- Protocols versus practice: unravelling clinical checking variations in community pharmacies in England-a multi-method study.International journal of clinical pharmacy · 2024Article
- Towards understanding and improving medication safety for patients with mental illness in primary care: A multimethod study.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Types, predictors, and consequences of medicines related problems (MRPs) in frail older adults admitted to hospital from primary care - A retrospective cohort study.Exploratory research in clinical and social pharmacy · 2024Article
- Enhancing access to primary care is critical to the future of an equitable health service: using process visualisation to understand the impact of national policy in the UK.Frontiers in health services · 2024Article
- Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review.Systematic reviews · 2023Article
- Enhancing Patient Safety Culture in Hospitals.Cureus · 2023Review
- A qualitative exploration of patient safety in a hospital setting in Spain: Policy and practice recommendations on patients' and companions' participation.Health expectations : an international journal of public participation in health care and health policy · 2023Article
- Involving patients and carers in patient safety in primary care: A qualitative study of a co-designed patient safety guide.Health expectations : an international journal of public participation in health care and health policy · 2023Article
- Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people.Health expectations : an international journal of public participation in health care and health policy · 2022Review
- "Death audit is a fight" - provider perspectives on the ethics of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Ethiopia.BMC health services research · 2022Article
- Rural general practice staff experiences of patient safety incidents and low quality of care in Norway: an interview study.Family practice · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveStudies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model.
methodMeta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies.
resultsForty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system.
conclusionOverall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.