Patient safety is a worldwide problem with many countries grappling with the issue. A vast number of stakeholders, NGOs and organisations also exist to offer professional advice, services and publications. In resource-constrained healthcare environments, it is important to try not to waste time and money reinventing the wheel when proven solutions are already in place in other countries. Global knowledge sharing and learning helps all countries, regardless of income level, and this needs to be encouraged.
We know that keeping up to date with the latest information in patient safety is a difficult task given the large amount of information from a variety of sources.
‘Trusts receive too many safety-related messages from too many different sources. The trusts we spoke to said there needed to be better communication and coordination between national bodies, and greater clarity around the roles of the various organisations that send these messages.’
When we add to the mix the growing body of international patient safety information, the learning obligation cannot always be met.
Global learning and sharing
A joint report by the World Health Organization (WHO), Organization for Economic Co-operation and Development (OECD) and The World Bank has highlighted the need for global patient safety learning and sharing (WHO et al, 2018). The report highlights the need for a global platform from which countries can share patient safety solutions. Sharing learning experiences globally is a universal good that benefits both developed, developing and transitioning countries. An earlier report from WHO clearly put the issue in context:
‘Ensuring the safety of patients is a high visibility issue for those delivering health care—not just in any single country, but worldwide. The safety of health care is now a major global concern. Services that are unsafe and of low quality lead to diminished health outcomes and even to harm. The experience of countries that are heavily engaged in national efforts clearly demonstrates that, although health systems differ from country to country, many threats to patient safety have similar causes and often similar solutions.’
Patient harm is the 14th leading contributor to the global disease burden:
‘Approximately 15% of hospital expenditure and activity in OECD countries is attributed to safety failures. However, many adverse events are preventable.’
Although the context in which care is delivered across countries will differ the common denominator is human beings. We are dealing, essentially, with interactions between professionals and patients with common, relatable facets such as proper communication strategies.
USA: Top ten concerns
The ECRI Institute in the USA has recently produced a report listing what it says are the top ten patient safety concerns, identified from various patient safety organisation databases and other sources:
The report goes into detail on each of these concerns and offers advice on dealing with the issues. For example, under concern 7, developing and maintaining skills, key findings are outlined:
‘ECRI Institute has received reports of adverse events occurring because a healthcare professional was unfamiliar with equipment, such as infusion pumps and robotic-assisted surgical systems, or lacked competence with procedures and processes, ranging from Foley catheter insertion to management of a hemorrhaging patient after childbirth.’
Canada: public awareness
The Canadian Patient Safety Institute (CPSI) promotes awareness and knowledge of patient safety issues. It was established by Health Canada in 2003 and works with governments, health organisations, leaders, and healthcare providers. The CPSI produces some excellent patient safety resources for the public, providers and leaders, which have relevance globally.
A recent report discusses public awareness of the patient safety crisis in Canada and there are several useful findings that have global relevance (CPSI, 2019). Public awareness of patient safety issues was explored to provide a baseline read of understanding. Information was sought to see how Canadians prioritise, experience, understand patient safety. An objective was also to determine how Canadians would like to receive information about patient safety, if at all.
CPSI sets the scene for discussion with some worrying statistics:
‘However, every resident of Canada must learn that there are risks in our healthcare system, despite the efforts of thousands of dedicated healthcare providers across Canada. In our healthcare system, there is a death from patient harm every 13 minutes and 14 seconds. It is the third leading cause of death in Canada. One out of 18 hospital visits result in preventable harm. These incidents generate an additional $2.75 billion in healthcare treatment costs every year. This level of harm is simply unacceptable.’
The report discusses the results of a commissioned survey of 1003 Canadian adults, weighted by gender, age, region and income. The CPSI argues that Canadians show limited knowledge of patient harm. One third of Canadians rank patient safety in their top three healthcare priorities, with just under one in ten ranking it first. Six in ten say the $2.75 billion cost of patient safety incidents in Canada is higher than they expected. Despite the limited knowledge of the patient safety crisis in Canada one in three Canadians have experienced a patient safety incident:
‘Misdiagnosis, falls, infections and mistakes during treatment are the most common types of patient safety incidents. Those who have experienced a patient safety incident most commonly cite distracted or overworked health care providers as the largest contributing factors that led to the incident.’
Once Canadians are informed about the scale of the problem, they demonstrate far more concern and want more information. Three in four Canadians are interested in learning how to keep safe in health care; 80% they would like to receive this information delivered via (in order of preference) healthcare provider, print, digital and in person:
‘This knowledge should be provided in real time (when patients go to the hospital for surgery and upon a new diagnosis of a serious health problem), but some also believe it should be general knowledge.’
The CPSI initiative is to be welcomed and it is a bold move in terms of public accountability of the healthcare system. There is a clear acknowledgement that there is a patient safety crisis. This appears in my opinion to be in stark contrast to the NHS message to the public. The NHS seems to communicate clearly with staff about patient safety issues, but I have not seen the same evidence of the proactive CPSI approach used by the NHS towards patients and the public. Such an approach would help galvanise the development of an NHS patient safety learning culture by adding public pressure.
In Canada, the aim is for the public to clearly see the nature of the patient safety problem. People are given the statistics and invited to play their part in taking some responsibility for ensuring their own safety and the quality of care provided. The CPSI asks the public to find out what more they can do to make people safe and directs them to resources such as, five questions to ask about your medicine, tips and tools for talking to your healthcare team, tips to identify deteriorating patient condition, ‘shift to safety’ tools and resources to keep you safe. The public are also encouraged to share what they have learned on social media.
Scotland: falls case studies
Healthcare Improvement Scotland's ihub website also has lots of useful patient safety reports and information that can be shared (https://ihub.scot). The organisation is a public body and part of the NHS in Scotland. It has several functions including inspections and reviews, enabling health and social care improvement, and the Scottish Patient Safety Programme (http://tinyurl.com/y29sl4er). The Acute Adult arm of the latter produced a report on falls and falls with harm in acute hospitals. Falls remain a common cause of harm to patients in acute hospitals with as many as 27 000 falls (6.7 per 1000 occupied bed days) recorded in Scotland every year. Visits were made to four NHS boards who were reporting improvement rates in falls prevention, and the report provides case studies from these visits and identifies common success themes and activities (Scottish Patient Safety Programme Acute Adult team, 2018).
Culture change was an important issue identified in successful falls prevention strategies. Falls were viewed as a multi-professional priority. There was a vision that falls were not inevitable, and recognition that falls incidence could not be taken in isolation from the care environment and the clinical needs and condition of the patient. There was use of data and patient stories to influence change and encourage staff to test and develop their own change ideas. The report contains several other findings showing how falls can be prevented and how improvements are generated.
Conclusion
There is a global patient safety problem, which is increasingly becoming recognised across the world. On the other hand, there is evidence that staff are finding it difficult to keep up to date with the wealth of patient safety information being generated.
There is also useful global information available, which also needs to be captured and shared. Different perspectives on patient safety issues can refresh policy making, which may become stale and ossified over time. The problem remains of how to do this, considering the workloads of nurses and doctors and a resource-constrained, busy care environment.