WHO defines patient safety as 'the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum'. By extension, unsafe care involves the presence of avoidable, preventable harm or the failure to reduce the risk of unnecessary harm during healthcare delivery. Fact sheet: https://www.who.int/news-room/fact-sheets/detail/patient-safety
WHO estimates that 'Around 1 in every 10 patients is harmed in health care and more than 3 million deaths occur annually due to unsafe care. In low-to-middle income countries, as many as 4 in 100 people die from unsafe care'. https://www.who.int/news-room/fact-sheets/detail/patient-safety
In previous discussions on HIFA we have noted that poor-quality care is estimated to account for 5 million deaths in 2016 [1]. This figure applies to LMICs. Clearly, if all countries were included, the number would be higher. Furthermore, we contacted the authors and established that the numbers only include facility-based care. They do not include home care or care by community health workers. The actual number of deaths caused by low quality care is certainly much higher than 5 million.
What is the difference between 'low-quality care' and 'unsafe care'? Some have argued that 'unsafe care' is a subcategory of low-quality care. However, I would argue that any low-quality care that results in death is by definition unsafe.
I would be interested to hear your thoughts on this.
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
[1] Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet. 2018 Nov 17;392(10160):2203-2212. doi: 10.1016/S0140-6736(18)31668-4. Epub 2018 Sep 5. Erratum in: Lancet. 2018 Nov 17;392(10160):2170. doi: 10.1016/S0140-6736(18)32337-7. PMID: 30195398; PMCID: PMC6238021.