Patients should be empowered to "stop the line" when they suspect something is wrong with their care, according to a November 22, 2018, editorial in BMJ Safety and Quality. The concept of stopping the line originated in the manufacturing industry; workers would hit a red button to literally stop an assembly line when they suspected that something had gone wrong. Managers were at first skeptical about this process, the authors note, but teams that employed this method became faster and more reliable and "stop the line" soon became industry standard. It is time for this approach to be used in healthcare, the authors say. Currently the onus to push a figurative button when something goes wrong falls on clinicians. However, the authors suggest, patients hold unique knowledge and have repeatedly demonstrated the ability to identify problems with their care, "including ones missed by clinicians." Empowering patients to stop the line, the authors believe, will improve clinicians' listening skills so that when patients speak up, they will truly be heard, and the practice will help ensure that transparency, patient engagement, shared decision-making, and inclusivity become the norm. It may also suggest new research questions on the benefits of speaking up. "True patient engagement requires fully making room for patients at the table, enabling those who feel unsafe to stop the line," the authors conclude.

HRC Recommends: Involvement of the patient in his or her care strengthens patient safety and optimizes outcomes of care; however, because patients and physicians remain accustomed to the tradition of "doctor knows best," which relegates patients to a passive role, patients may need to be empowered by their physicians to ask questions and express their feelings. Patients should be encouraged to feel that they can do so in a safe environment that is open to their voices and concerns. Healthcare organizations should encourage patients to speak up when something does not seem right about their care. Similarly, organizations should encourage providers to listen to and address patients' concerns rather than dismissing those concerns as unimportant. Some organizations have invited patients and family members to call for a rapid response team if they have unresolved concerns about a patient's safety and health. Risk managers should use monitoring of rapid-response-team activation as a risk identification strategy.