Patient safety is a political, not physician’s problem in Pakistan and you need to create a culture of professionalism-Paul Barach


 International Conference on Patient Safety at AKU

Patient safety is a political, not physician’s problem
in Pakistan and you need to create a culture
of professionalism - Paul Barach

Most doctors do not observe Hand Hygiene and we need to
have Patient Safety Friendly Hospitals - Lt.Gen. Zahid Hamid

We need to overcome professional barriers and measure
clinical outcome- Johannes Kedzierski

Let us develop a system whereby patients are able to protect
themselves from harm in Hospitals-Hassan M. Khan

KARACHI: Patient safety is a political problem and not a physician’s problem in Pakistan and you need to create a culture of professionalism. This was stated by Dr. Paul Barach from Wayne State University United States of America. If Road Traffic Accidents are prevented, it will reduce workload on healthcare facilities to a great extent.  He was delivering a Thematic Keynote address at the 2nd International Conference on Patient Safety jointly organized by Riphah International University Islamabad and Aga Khan University at AKU Campus from October 28-29th 2017. The topic of his presentation was “Systems and Reality- why is it so difficult to improve patient safety”. He started his presentation in a rather dramatic style asking the audience to stand up if they or any one of their relatives has ever been harmed while in a hospital to which almost all the participants stood up. This showed the magnitude of the problem.

Continuing Paul Barach showed a slide of half a dozen people including children going on a Motorcycle and a Suzuki van full of people moving on the road. If an accident takes place, the number of casualties and injuries will be too many under such circumstance. He further pointed out that we need to develop a professional charter. After heart diseases and Cancer, Medical Errors is the third leading cause of death and disability. When outcome of surgery was measures comparing the results of surgery performed on Friday vs. Monday, in house mortality was greater in case of surgeries performed on Friday or at the week end. You need to work on normalization of risk to healthcare workers in Pakistan. There are lot of challenges of economic and time pressure. There is no Health Insurance, more regulations. Pakistan spends just 2.6% of its GDP on Health whereas its neighboring countries like India and Sri Lanka spend 4-4.2% of their GDP on Health. Politicians have to allocate more resources for Health. Pakistan has the distinction of having the highest Infant Mortality which is 40.7 per thousand live births. Road safety was another big challenge.  Problems should not be created in the first place. In Pakistan one finds very little about health in the media. Society has increased expectations from medical profession. They need medical professionals who are accountable for their actions. Physicians expect to have Trust and Freedom. Use of surgical check list prepared by the WHO in the operation theatre will reduce mortality. Pakistan need to have a Patient Safety Act and train all healthcare professionals in patient safety culture. Measure outcome of safety. You also need to establish Patient Safety Organizations since systems and cultures are all very important, he added.

Riphah International University in collaboration with Aga Khan University organized an international
conference on Patient Safety. Group photograph taken on the occasion shows some of the invited
speakers and officials of RIU as well as AKU and some members of the organizing committee.

Surgeon General Pakistan Army Lt. Gen. Zahid Hamid who was the Guest of Honor on this occasion in his speech stated that the pillars of Medical Ethics remain the same. Patient safety was extremely important and it was essential that first we do no harm to the patient. We are now approaching the post antibiotic era. We need to conduct studies on Evidence Based Practices. Sale of drugs and medicines over the counter needs to be stopped and we can do it if we all work together. According to reports one in ten patients suffer from Adverse Drug Reactions in developing countries. We all know the patients demanding Pink Infusions to get energy. Most of the doctors are not interested in Hand Hygiene. We need to have Patient Safety Friendly Hospitals and Private health sector was doing a commendable job, he added.

Earlier Chief Executive Officer of Aga Khan University Mr. Johannes Theodorus Kedzierski speaking at the occasion said that striving for high quality of care was their Mission. AKUH was a 750-Bed Hospital with four secondary hospitals, a chain of two hundred fifty laboratories and seven thousand employees. We always need to think is this Hospital Safe? Do we have infection control policy in place? Are our nurses trained, machines calibrated, physicians privileged to do procedures, are they trained to do that? We opted for accreditation to get international recognition. JICA accreditation was achieved in 2015 while CAP accreditation for laboratory was earned in 2017. It is important that quality is seen everywhere starting from porter to nursing care and medical performance. It is a painful exercise which covers all details. LASA drugs has a potential of medical errors. It is said that if care is not documented, it is not given. He also highlighted the importance of hand hygiene, verbal orders. All this, he stated, was not easy but a real challenge. It is important to ensure that the patients do not suffer from Hospital Acquired Infections. There are some professional barriers in medicine and we would like to measure the clinical outcome. Physicians generally do not like inspections by JICA which they consider as interference in their freedom. Once a physicians remarked that Transparency is the end of our freedom. He also talked about the passion of the professionals and opined that they must be on the ground and never compare a memo with reality.

Mr. Hassan Mohammad Khan Chancellor of Riphah International University Islamabad in his speech said that in Pakistan we often face system failure and have poorly connected healthcare. Even in developed world like USA medical error is considered as the third leading cause of death and hospital admissions. We need to develop a system that patients are able to protect themselves from harm in Hospitals. We need to develop a protective culture and mindset leading to patient safety. Systems of improvements should be embedded in medical education curriculum. We need to implement systematic changes in the way we deliver healthcare in Pakistan.

Prof. Anis Ahmad Vice Chancellor of Riphah International University read the Declaration on Patient Safety which was approved by the audience. He laid emphasis on improving ethics and morality, reinforcing ethical standards. There are certain norms which he said, we all must follow. We need to come up with policies which encourage patient safety, provide safe space for people to report, measure performance, and develop indicators and data systems. It was also suggested that Patient Safety Days should be celebrated by the Provincial and Federal Governments every year.

Prof. Shabbir Lehri President of Pakistan Medical & Dental Council laid emphasis on improving the standard of medical education. Rear Admiral Surgeon Najum Saqib pointed out that patient safety was cornerstone of healthcare quality system. Mr. Naveed Kamran Baloch Federal Secretary Ministry of National Health Services presenting the Patient’s point of view emphasized the importance of professional ethics and behaviour of healthcare professionals. There was a need to create awareness about patient safety and the Government, he said, will support any effort to finalize Patient Safety Act. After the passage of the 18th constitutional amendment, service delivery has become the responsibility of the provincial governments but unfortunately none of their representatives was present in the meeting, he remarked.

Dr. Zakiuddin Ahmad Chairman of ICPS presented the Vote of Thanks thanking all those who worked hard to organize this conference.