Speak Up for Patient Safety

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Speak Up for Patient Safety
A well-coordinated, timely, measurable
national patient Safety initiative is
needed with a multipronged approach
Dr. Muhammad Hasan Abid* 

No one should be harmed when receiving healthcare. Safe healthcare service delivery forms the first pillar of high-quality patient care, a basic patient right that lays foundation of medical practice through doctrine of ‘first do no harm’. However, millions of patients across the globe suffer avoidable harm, or are put at risk of injury, while receiving healthcare every single day. Medical errors are a leading cause of death around the world, accounting for 2.6 million lost patient lives annually in low- and middle-income countries alone. The resulting personal, social and economic impact of patient harm due to medical errors leads to losses of trillions of US dollars. World Health Organization Director General, Dr. Tedros Adhanom Ghebreyesus reports that at least 5 patients die every minute because of unsafe care.

In Pakistan, an estimated half a million patients die annually due to preventable medical errors. These numbers are rather an underreporting given the current mechanisms in place for recording the patient harm. Among such cases, a recent well highlighted and heart retching unfortunate loss of the baby girl Nashwa due to a preventable medical error. Most common medical errors are related to process involved in diagnosis, medication, unsafe care practices and communication failure. Unfortunately, under current scenario the heat of broken healthcare system is only faced by those at the front lines. The culture of blame and wide spread ignorance of systems thinking with in the healthcare sector allowed the real responsible culprit a ‘sustained dysfunctional system’ to get away year after year placing the lives of patients at risk. The result is none but waiting to go back to business as usual once the bereaved families have stopped protesting or received other remunerations, placing another patient at risk in near future to experience the similar incident again.

Most critical piece in dealing with the medical errors is to learn from them by recognizing that they are indeed preventable and not due to an individual provider level failure. Instead medical errors occur due to existing dysfunctional processes that set up a healthcare provider to fail at the sharp end of the healthcare system. Next, it is vital to deploy preventive strategies to proactively mitigate process and system level risks to prevent medical errors from recurring.

To be a true ‘change maker’ in improving patient safety within the healthcare eco-system requires strong leadership, policy development and constant evolution of information technology by recognizing that broken healthcare system of Pakistan is in need of fixing, and unless done so it will remain highly unsafe by putting many patients at risk of death from preventable medical errors. Patient safety should be viewed as a matter of urgent attention and above political, corporate or personal point scoring. All the federal, national and private healthcare stakeholders – medical schools, nursing schools, pharmacy schools and allied health professional schools, postgraduate training bodies, hospitals’ management, regulatory bodies, healthcare commissions, health ministries, healthcare workforce, and patients and families have their unique role in preventing the medical errors by tenaciously working together to improve and evolve Pakistan’s healthcare system.

The health care in modern era is considered as a service where the outcomes are coproduced by the interaction of the patients and families with the healthcare system through their journey of seeking health. Patients are central to any healthcare system around the world as the quality of service delivered to them translates to the mere structures and processes that derive their health outcomes. A well-coordinated, timely and measurable national patient safety initiative which engages all the levels of care continuum across a patient’s journey in the health system through a multipronged approach is required. The goals of such initiative should be reviewed and renewed annually and progress must be shared transparently with the most important consumer of the healthcare systems, the patient themselves. Patient safety and quality of care are essential for delivering effective health services and achieving universal health coverage. Investment in improving patient safety can lead to significant financial savings as the cost of prevention is much lower than the cost of treatment due to harm. In the United States alone, focused safety improvements led to an estimated US$28 billion in savings between 2010 and 2015. Greater patient involvement and engagement is the key to safer care which can reduce the burden of preventable harm by up to 15%, saving billions of dollars each year as per World Health Organization.

Patient safety is everyone’s business and no professional in the healthcare field have an intention to harm their patients. One factor that allows preventable harm to reach the patients is not speaking up when seeing or coming across a patient safety concern in a healthcare setting. Speaking up for patient safety requires courage and deliberation in addition to sound implementation of a ‘just culture’ and principles of psychological safety. In essence, it is the patient safety culture that promotes partnership with patients, encourages reporting and learning from errors, and creates a blame-free environment where health workers are empowered and trained to reduce errors. Speaking up for patient safety can take various forms: an activated patient questioning the need for a test, a junior medical student speaking up in operation theater as soon as a breach in sterile field is observed, a nurse flagging a medication contraindication or management officer bringing below-benchmark data to a healthcare leader’s attention. Speaking up for patient safety emphasizes why using the power of voice and observations is essential to patient safety improvement around the world. World Health Organization is calling for an urgent action by countries and partners around the world to reduce patient harm in healthcare by declaring patient safety as the global health priority and kicking off the inaugural world patient safety day on September 17, 2019. The main theme for the world patient safety day this year is to speak up for patient safety by realizing that patient safety is a collective responsibility of all the professionals in a healthcare system.

The World Health Organization as a parent healthcare watchdog for the universal healthcare coverage has already spoken up for patient safety by prioritizing the issue globally. Healthcare leaders in the country need to responsibly act in time by working with bold determination to change the face of healthcare through a culture of innovation by placing patient safety among top priorities for our nation’s health. Resource availability is not an answer for staying away from such initiatives. There are existing opportunities within the current healthcare system that can result in improving patient safety in a cost-effective manner. The spectrum of possible actions is broad with areas of opportunities existing from Integrating the patient safety curriculums during the medical training and requiring the patient safety competencies for licensure as a practitioner, to standardized accreditation process and mandatory patient safety reporting for all the healthcare establishment, linking quality and patient safety indices to enrollment of healthcare establishments to programs like health card or private insurance, utilizing innovative information technology based solutions in the form of incident reporting system and electronic healthcare delivery platforms to enhance patient safety, and engaging patients to act as a safety net. Patient harm in health care is unacceptable. It is a need of the hour that Pakistan have a measurable, transparent and accountable national road map for robust healthcare quality improvement and enhanced patient safety.

*Dr. Muhammad Hasan Abid, MBBS, GCSRT-PGCert (Harvard), MHQS (Harvard)
Fellow - Institute for Healthcare Improvement, Boston, MA, USA

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