Dear HIFA colleagues,
As a reminder, our guiding questions are:
1. What is unsafe care and what is its local and global impact?
2. What are the main causes of unsafe care for people living with NCDs? To what extent is access to reliable healthcare information a determinant of patient safety?
3. What can be done to better understand and improve health systems for safer care for people living with NCDs?
4. How can we better support patients and primary and facility-based health workers to deliver safe care?
www.hifa.org/patientsafety
Here are some highlights from our discussion so far in relation to Question 3. What can be done to better understand and improve health systems for safer care for people living with NCDs? I have added a comment from me below.
1. “We have learned over many years that the real causes lie in weaknesses in healthcare systems.”
2. “Understanding these gaps is the first step toward designing safer, more resilient systems.”
3. “Countries should establish stronger patient-safety surveillance and incident-reporting systems, conduct routine quality-of-care audits, map NCD care pathways, strengthen referral and counter-referral, and use patient and community feedback.”
4. “Primary healthcare should be strengthened as the foundation for prevention, early detection, treatment and long-term follow-up.”
5. “Digital health records, decision-support tools and interoperable information systems can improve continuity and reduce errors.”
6. “There are a variety of techniques that can be used to assess the system. These include process mapping, incident analysis, interviews, observation and ethnography.”
COMMENT (NPW):
With regard to 1, for me the first question that arises is: how can we categorise the 'real causes in healthcare systems'.
The WHO fact sheet notes the following:
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Factors leading to patient harm
Patient harm in health care due to safety breaks is pervasive, problematic and can occur in all settings and at all levels of health care provision. There are multiple and interrelated factors that can lead to patient harm, and more than one factor is usually involved in any single patient safety incident:
- system and organizational factors: the complexity of medical interventions, inadequate processes and procedures, disruptions in workflow and care coordination, resource constraints, inadequate staffing and competency development;
- technological factors: issues related to health information systems, such as problems with electronic health records or medication administration systems, and misuse of technology;
- human factors and behaviour: communication breakdown among health care workers, within health care teams, and with patients and their families, ineffective teamwork, fatigue, burnout, and cognitive bias;
- patient-related factors: limited health literacy, lack of engagement and non-adherence to treatment; and
- external factors: absence of policies, inconsistent regulations, economic and financial pressures, and challenges related to natural environment.
- technological factors: issues related to health information systems, such as problems with electronic health records or medication administration systems, and misuse of technology;
- human factors and behaviour: communication breakdown among health care workers, within health care teams, and with patients and their families, ineffective teamwork, fatigue, burnout, and cognitive bias;
- patient-related factors: limited health literacy, lack of engagement and non-adherence to treatment; and
- external factors: absence of policies, inconsistent regulations, economic and financial pressures, and challenges related to natural environment.
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What approaches or tools can be used in different clinical contexts, especially in low-resource environments and in primary care?
On point 4, “Primary healthcare should be strengthened as the foundation for prevention, early detection, treatment and long-term follow-up”, how does this look in practice to 'strengthen' primary care, especially in LMICs?
On point 5. “Digital health records, decision-support tools and interoperable information systems can improve continuity and reduce errors”, this makes a case for universal access to electronic health records and integration of health records with decision-support tools. Which countries are making the most progress in this direction?
On point 6. some but by no means all facilities routinely audit their services, including where care goes wrong. In other cases incidents are not analysed or are 'swept under the carpet'. What is the basic minimum that should be done to analyse incidents, and which guidance is most useful, especially for overworked, understaffed settings in LMICs?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org