[Re: https://www.hifa.org/dgroups-rss/spotlight-patient-safety-and-ncds-41-q1... ]
Dear HIFA Community
Neil posed some important questions of definition asking about how harm is defined and what do we mean by unsafe care. WHO it seems do not have an accessible definition on their website.
This is quite a complex issue as one can define harm in various ways and clearly it overlaps, as Neil pointed out, with care that is simply of very poor quality.
Patient safety was founded in part on the class studies of ‘adverse events’ beginning with the Harvard Medical Practice study in the 1980s. This and similar studies systematically reviewed records of patients admitted to hospital looking for occasions where a patient suffered an ‘adverse event’. They defined an adverse event as some harm that came to the patient as a results of problems in healthcare rather than their disease. This could be something that went wrong in treatment (wrong site surgery), a more general form of harm (such as hospital acquired infection) or failures of other kinds (like a missed diagnosis). Their criterion for labelling something a ‘harm’ was that it was sufficiently serious to require an extra day in hospital.
There have been many similar studies in many countries since then. Most used the same definition of adverse events and the same denominator of hospital admission. So, when a figure of 10% is quoted it means that 10% of patients going into hospital suffer some kind of harm during their stay, about half of which are generally judged to be preventable. Many of these are not serious, but a small number are very severe.
Clearly one can use different definitions of unsafe care and poor quality care but this is probably the most common one in use in studies of harm to patients in hospital.
Best wishes
Charles
HIFA profile: Charles Vincent trained as a clinical psychologist and worked in the British NHS for several years. Since 1985 he has focused on conducting research on the causes of harm to patients, the consequences for patients and staff, and methods of improving the safety of healthcare. charles.vincent AT psy.ox.ac.uk