The first World Patient Safety Day took place on 17 September 2019, a new addition to the World Health Organization's (WHO) list of officially mandated global public health days. On the day WHO launched a campaign, ‘Speak up for patient safety’, to create awareness of patient safety and to urge people to show their commitment to making healthcare safer (https://tinyurl.com/yypz6snx).
‘World Patient Safety Day provides a focal point for healthcare and patient safety bodies, all over the world, to recognise the work they are doing and to share intelligence and resources with other organisations to improve patient safety system-wide.’
The publicity generated by World Patient Safety Day has worked to focus national and global attention on the issues of patient safety. The NHS and many other healthcare organisations, together with governments across the world, posted on social and national media their patient safety activities. Some governments lit up national buildings in the campaign's colour, orange, to celebrate the day and to show commitment and solidarity to the need for safer care.
Patient safety: a global problem
As the NHS implements the new NHS Patient Safety Strategy (NHS England and NHS Improvement, 2019), the experiences of other countries can help inform policy makers and lessons can be learned and shared. The concept of ‘Never Events’ was originally an import from the USA. There is an NHS Never Events policy and framework and Never Events list (https://tinyurl.com/ybr8sluq). NHS Improvement defines Never Events as:
‘Patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers.’
Patient safety policy makers and implementers should not be confined to working in academic, conceptual and country silos. There is a wealth of literature available globally and some of it is being referenced in NHS patient safety initiatives. Maintaining a comparative, international perspective on patient safety does enable fresh perspectives to be gained on many issues and there are global trends. Best practice can be shared globally and wasting scare resources by reinventing the wheel can be avoided:
‘Although the burden of safety varies from country to country, there are clear trends that exist on a global level. The result is that, while specific interventions will require cultural and contextual adaptation, the general recommendations for improvement are universal.’
One benefit from World Patient Safety Day was that the issues and debates surrounding safe patient care were made available to a non-professional, lay audience. Key information was explained in a non-technical way that everyone could generally understand. The messages of World Patient Safety Day contained stark statistics that gave impact to the messages being conveyed. The WHO press release heralding the day stated that globally at least 5 patients die every minute because of unsafe care, while Four out of every ten patients are harmed during primary and ambulatory health care (WHO, 2019).
Global State of Patient Safety
On World Patient Safety Day an important report was launched at Imperial College London on the global state of patient safety (Flott et al, 2019). The report clearly conceptualises global problems and provides a roadmap for taking matters forward. There are discussions of the global burden of unsafe care, countries' progress towards patient safety and future outlook.
Global burden of unsafe care
Patient safety is now an established cornerstone of healthcare quality. The discipline has evolved and is now a topic of some political importance globally:
‘As the discipline around safety has evolved and attracted political attention, patient safety has become recognised with international importance. As of May 2019, patient safety has been enshrined as a global health priority via a World Health Assembly Resolution. The trajectory towards global importance has taken decades, but the case for safer care has been consistently strong.’
The point is also made that safety is a multifactorial concept driven by a complicated number of different factors. The clinical burden of unsafe care is discussed, and several alarming statistics are given on the extent of unsafe care, globally. Unsafe care is one of the top ten leading causes of death in the world and up to 83% of harm is avoidable. In the USA it is estimated that every adult will experience a diagnostic error at least once during their lifetime. The risk of harm ‘is far more pervasive than many may assume’ (Flott et al, 2019:6).
Maternity and neonatal care is discussed and WHO figures are quoted stating that every day, 830 women die from preventable causes relating to pregnancy and childbirth. Childbirth is also discussed in the UK:
‘In the UK 9 in every 100 000 mothers still die in pregnancy-related cases, a ratio incongruent to the available services in the UK and higher than the UN's Sustainable Development Goal of 7 in every 100 000.’
The statistics quoted leave the reader in no doubt that patient safety is a global as well as a national urgent problem to address. The broader impact of unsafe care is also discussed. Unsafe care does not only have clinical and economic impacts; there is also the personal impact on the patient, carers, family and the healthcare staff involved. Loss of trust in the healthcare system can also result—both personally and on a national scale.
Patient safety and trust
Despite past patient safety crises, patient trust in the NHS remains high, as the NHS Adult Inpatient Survey found:
‘The results show that many aspects of patient experience have remained relatively stable in the past 10 years. For example, trust in doctors and nurses remains relatively high, most patients (over 90%) report that they had enough privacy, and communication between patients and staff remains a positive experience for most.’
This finding should not result in complacency on the part of the NHS as the figures for World Patient Safety Day and highlighted by Flott et al (2019) show that there is a global unsafe care crisis. Unsafe care remains one of the leading causes of death in the world and, as my previous columns have shown, endemic patient safety problems exist in the NHS in England.
World progress
Flott et al (2019) discuss how patient safety improvements can be made and knowledge translated across borders. There is a need to leverage a new paradigm for safety, learning from best practice. There is a discussion of various global patient safety movement milestones that have contributed to creating more global interest in patient safety and the need to make the most of this progress:
‘Capitalising on the momentum in order to drive safer policies and practice requires a clear understanding of the state of healthcare safety systems across the world, both in terms of their qualities and their challenges.’
The importance of measurement and comparisons is stressed in the report. Improving patient safety should not be viewed as a competitive mission for just a single system to master. A global collaborative approach is needed. International variation in safety and quality is discussed with reference to several studies. Over time the field of patient safety has evolved in focus from quantified harm to observed best practice. The report contains some world mapping of rates of mortality due to poor-quality health care and rates of death due to adverse medical treatment. The maps expose a concerning global state of patient safety, especially in low and middle income countries (LMIC). Several institutional drivers are noted that can help build safe systems (Flott et al, 2019:24):
Future outlook
Flott et al's (2019) report states that safer health care is an important juncture on the road to ‘universal health coverage’ (UHC). However, the global burden of unsafe health care can be an impediment to achieving UHC and could also result in not meeting the third UN sustainable development goal of achieving access to quality health services. An argument that has increasingly been made in discussions about patient safety and UHC is that if a country can afford to provide any healthcare services then these must be of good quality. If that cannot be guaranteed, then the money would be best spent elsewhere on other services.
‘Universal health coverage should not be discussed and planned, let alone implemented, without a focus on quality.’
Threats and opportunities from innovation are discussed in the report. Digital and data-driven interventions in health care give rise to new patient safety risks. Research in these new areas will be needed. Artificial intelligence algorithms will also need to be analysed from a patient safety standpoint along with cyber threats. The importance of patient safety education and training for healthcare workers and patients is also discussed.
Conclusion
The first World Patient Safety Day prompted many healthcare organisations and governments to reflect on patient safety issues, to do something positive to mark the day and to think about the future. The call to arms from WHO has been met and hopefully sustainable progress will be made globally towards making health care safer.
Flott et al (2019) have produced a seminal report on global patient safety and conclusively shown the need for countries to work cooperatively on issues. There are common world patient safety trends and we can all learn from each other. As the new NHS Patient Safety Strategy moves forward it is important that policy makers guard against working in old policy silos, drawing on a restricted number of academic and practice disciplines. A more expansive, global, comparative approach needs to be the order of the day.