The second World Patient Safety Day was held on 17 September 2020. The World Health Organization (WHO) (2020a) made a call for global support, commitment and collective action by all countries and international partners to improve patient safety. The theme this year was health worker safety, marked with the launch of a health workers safety charter (WHO, 2020b). The Charter calls for actions to better protect health workers:
‘These include steps to protect health workers from violence; to improve their mental health; to protect them from physical and biological hazards; to advance national programmes for health worker safety, and to connect health worker safety policies to existing patient safety policies.’
Common sense dictates that to keep patients safe you also need to keep health workers safe. The COVID-19 pandemic has shown the world how important healthcare worker safety is and how vulnerable they are to risk of infection (WHO, 2020b).
The annual WHO World Patient Safety Day campaign is a welcome one—an opportunity for countries, governments, health systems, organisations, health carers to join to demonstrate commitment and resolve to the patient safety cause. Social and other media on the day this year seemed to fully capture the spirit of the campaign with activities, blogs, podcasts and articles on the current theme.
International resources of note
Keeping with the global patient theme, important patient safety policy resources have been recently published in Canada and the USA, from the Canadian Patient Safety Institute (CPSI) (2020), and from the National Steering Committee for Patient Safety (NSC-PS) (2020). They contain a lot of well-researched anaylsis on common problems. It is always worthwhile consulting other countries' patient safety reports as they can address problems that are currently faced in the UK. Re-inventing the wheel can waste scarce financial resources. Although the healthcare delivery contexts may differ, they are still dealing with the same common elements of human beings and health.
Canada
The CPSI (2020) resource is designed to support teams across all healthcare sectors by using a knowledge translation and quality improvement integrated approach to change that will impact on patient safety outcomes:
‘Knowledge Translation (KT) and Quality Improvement (QI) draw from different evidence and methods but ultimately aim to achieve the same goal—improving patient outcomes. QI uses methods and processes to improve the quality, safety, and value of healthcare at a local level. KT uses theories, models, and frameworks to move knowledge gained from research evidence into practice for large-scale improvement.’
The resource includes discussion of assessing organisational readiness, importance of leadership, and the need to understand your own patient safety culture:
‘The interconnections between people, system and culture, and focussing on system improvement and learning rather than individual performance will drive actions for improvement.’
Engaging stakeholders, patients, families, forming implementation teams, enhancing teamwork and communication, assessing barriers, facilitators to change are also discussed.
USA
The Institute for Healthcare Improvement convened the NSC-PS, which is a collaboration among 27 national organisations committed to advancing patient safety. This produced a plan and supplementary resources. The National Action Plan concerns four key areas identified as essential to create total systems safety:
The report gives 17 recommendations under the above headings to advance patient safety, including (NSC-PS, 2020:17):
‘Total systems safety requires a shift from reactive, piecemeal interventions to a proactive strategy in which risks are anticipated and system-wide safety processes are established and applied across the entire health care continuum.’
The report has a section reflecting on patient safety efforts in general over the past 20 years. The point is made that improving safety is a journey. It considers what has hindered progress, and reasons include lack of robust safety cultures, effective teamwork, and meaningful patient engagement.
Patient safety: importance of patient and family engagement
Patient and family engagement featured in both the resources discussed above and is also discussed in a recently published report from England's Healthcare Safety Investigation Branch (HSIB)(2020). This gives a general overview of the HSIB approach: initial family contact, first meeting, purpose of the investigation, family interviews, ongoing communication, draft report, final report and completing and feedback. The HSIB has developed a library of literature to help families understand the investigation process and their role within it. Several of these documents have been produced with the assistance of families. HSIB stresses that the most crucial component of family engagement is the initial contact with the family. The adage ‘first impressions count’ is the directing focus here. The HSIB uses the definition of family (in the context of maternity and national investigations) as:
‘including “patients, mothers, partners, parents, siblings, children, guardians and others who had a direct and close relationship with the individual concerned”. It refers to the person or patient (the individual) to whom the incident occurred, their family and close relationships.’
The initial contact with the family is usually made by phone and it should be timely, sensitive, honest and informative. Overall, this is an excellent report giving good practical advice in an easily understandable manner.
Family involvement in adverse incident investigations has a critical role to play in an NHS that is trying to develop an ingrained patient safety culture. The Care Quality Commission (CQC) in its review of the way NHS trusts review and investigate the deaths of patients in England, found serious lapses in the way the NHS involves families in investigations when things go wrong (CQC, 2016). However, there are signs of progress being made in this area (CQC, 2019).
A comparative approach to patient safety
It is useful to have perspectives on common issues from different country standpoints. The messages in the reports are often similar. This can provide a useful sense of legitimacy and support for ongoing patient safety research work and policy development.
A key message in both the North American reports I highlighted is that there could be much improvement in the pace of reform:
‘Despite substantial effort over the past 20 years, preventable harm in health care remains a major concern in the United States.’
‘The journey to discover effective ways to improve patient safety has evolved a great deal in the past 15 years, but it is fair to say that there is still a lot of work needed.’
My BJN columns have expressed similar sentiments about the progress of the NHS in developing an ingrained patient safety culture. Although some progress has been made there is still an immense amount of work still to do.
Reality check and rollback
I began this column by sharing details of World Patient Safety Day and the cheerleading efforts of WHO for global support, commitment and collective action by all countries and international partners to improve patient safety. These are notable efforts and are to be very much welcomed, nationally in the NHS and globally. Everybody needs to be reminded of the importance of patient safety. On the day, social media was full of examples of excellent projects showcasing NHS commitment to patient safety. Several countries highlighted their efforts in the media and pictures appeared of national monuments being lit up in orange to mark the day—WHO (2020a) said that the orange colour symbolised the central role patient safety plays in countries' efforts to achieve universal health coverage.
All this was highly reassuring, but then we heard on the same day that mistakes made on maternity wards are costing the NHS in England almost £1 billion in lawsuits. Borland (2020) quoted Jeremy Hunt, the former Health Secretary, writing in the Daily Mail:
‘Mr Hunt says: ‘We have appallingly high levels of avoidable harm and death in our healthcare system. In healthcare we seem to just accept it as inevitable.”’
Yes, it is good to celebrate World Patient Safety Day, but we should also not forget that all is not well at home. Domestically we have major patient crises on an all too frequent basis. There is cause to celebrate what the NHS is doing in patient safety on a global platform but there is also another reality to consider. We must be careful not to let one eclipse the other.