World Health Organization · 1st edition, 2016 · 26 pages
WHO guidance on building capacity of patients, families and providers to actively involve patients in their own care to enhance safety and quality.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2016
- Audience
- Policy-makers, primary care managers, clinicians, patient safety leads
- Evidence
- Systematic review of 39 reviews; expert consensus on practical steps
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO technical monograph defines patient engagement as the process of building the capacity of patients, families, carers and health care providers to facilitate and support active involvement of patients in their own care to enhance safety, quality and people-centredness of primary care delivery. It systematically reviews evidence from 39 systematic reviews on patient engagement in safety across care settings, with extraction of primary studies specific to primary care contexts.
The document identifies five groups of factors affecting patient engagement (patient characteristics, health conditions, health care professionals, tasks and health care setting) and presents potential solutions organised into three categories: educating patients and providers, obtaining feedback, and engaging for improvement. Educational interventions have focused predominantly on medication safety, with mixed evidence for improving compliance; electronic medication safety messages and computerized tools have been found to reduce adverse drug events. Leaflets, videos and educational materials can encourage patients to raise safety concerns.
The monograph emphasizes that patient engagement must be implemented alongside other system improvements including workforce training, electronic tools, communication across care levels, and attention to higher-risk groups (children, older people, those with multimorbidity). It concludes with 10 key actions for safer primary care and specific priorities for WHO Member States, stressing that meaningful engagement requires empowerment through information access, cultural adaptation, and creating enabling environments where patients can speak up without fear of being labelled ‘difficult’.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Patient engagement encompasses involvement at three levels: individual direct care, organizational governance and systems design, and policy development through education, research, regulation and standard setting.
- Five factor groups affect patient engagement: patient characteristics (demographics, health literacy), health conditions (illness severity), health care professionals (knowledge and attitudes), tasks (whether patient safety behaviour challenges clinicians' abilities), and health care setting.
- Electronic medication safety messages and computerized educational tools have been found to improve engagement and reduce adverse drug events in primary care settings.
- Education delivered via post and telephone has been found to reduce adverse drug events in primary care.
- Patients at higher risk of safety incidents requiring focused engagement include children, older people, those in residential or nursing homes, people with multimorbidity, and those with combined mental and physical health issues.
- Retrospective feedback through surveys, online tools or formal patient event-reporting systems provides useful data not available from other sources but requires active teams to drive forward improvements.
- Open disclosure of safety incidents to patients and engaging patients and families in remedies is valued by patients.
- Health care providers should be educated that patient-centred consultations occur more frequently with patients perceived as better communicators, and that professional or technical jargon can act as barriers to communication.
From the guideline
Verbatim
“Engaged patients are better able to make informed decisions about their care options. In addition, resources may be better used if they are aligned with patients' priorities and this is critical for the sustainability of health systems worldwide.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively with WHO on health systems strengthening in the South Caucasus, I recognize that patient engagement is perhaps our most underutilized safety resource. In Georgia's rapid UHC expansion since 2013, we have prioritized access and infrastructure but not systematically empowered patients as active partners in their own safety. The evidence that electronic medication safety messages and structured feedback systems reduce adverse drug events is directly applicable to our growing e-health infrastructure. However, we must be realistic: deeply rooted cultural expectations of physician authority mean that campaigns to encourage patients to ask questions or report concerns will require parallel training of providers to welcome rather than resist such engagement. The recommendation I would stress to Georgian family physicians is to view patient feedback not as criticism but as vital safety intelligence that no other source can provide. The practical caveat is that simply collecting patient experience data accomplishes nothing unless we create dedicated mechanisms to analyze it and implement tangible changes—a resource-intensive commitment that most primary care clinics will need external support to establish.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance supports the region’s ongoing transition from paternalistic to patient-centred care models within primary care strengthening initiatives. Georgia’s 2013 UHC programme expanded access, making patient engagement essential to ensure quality and safety at scale. National programmes would need to consider cultural norms around patient-provider hierarchy that may deter patients from speaking up, low health literacy levels in rural populations, limited electronic health record infrastructure outside major cities, and the need to adapt engagement strategies for elderly populations and those with multimorbidity who represent growing proportions of primary care users. Implementation would benefit from integration with existing quality improvement frameworks in family medicine and ongoing primary care workforce training programmes across Armenia, Azerbaijan and Georgia.
Questions this guideline answers
Quick answers
What does patient engagement in primary care safety actually mean?
It means building the capacity of patients, families, carers and providers to facilitate and support active patient involvement in their own care to enhance safety, quality and people-centredness. This ranges from individual care decisions to organizational governance and policy development.
What prevents patients from engaging in their own safety?
Key barriers include patients perceiving their role as subordinate to clinicians, fear of being labelled 'difficult', providers using technical jargon, providers' perceptions of patient communication abilities influencing consultation style, and varying patient preferences for involvement in decision-making.
What educational interventions have been proven to improve patient safety in primary care?
Electronic medication safety messages and computerized tools have been found to improve engagement and reduce adverse drug events. Education via post and telephone has also reduced adverse drug events. Leaflets and videos encourage patients to raise safety concerns, though many studies focus on satisfaction rather than actual safety events.
How can primary care services practically start engaging patients in safety?
Start by collecting patient experience data through surveys, informal online feedback, interviews or focus groups. Educate providers about patient engagement and include it in curricula. Encourage patient reporting of safety incidents and near misses, actively promote feedback systems, give patients feedback on actions taken, and provide appropriate information in user-friendly language and format.
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- Issuer
- World Health Organization
- Type
- Technical document
- Edition
- 1st edition, 2016
- Status
- Current
- Published
- 2020-10-31
- Languages
- English
- Scope
- Global, all primary care settings
- Audience
- Policy-makers, primary care managers, clinicians, patient safety leads
- Pages
- 26
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789241511629
- Evidence
- Systematic review of 39 reviews; expert consensus on practical steps
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
World Health Organization. Patient Engagement: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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