Dr. Shyam P Lohani

We go to hospital to get cured of an ailment. But do you know we can get infections in the hospital while being treated for something else? Every day, thousands of patients acquire different infections from healthcare facilities. These nosocomial infections can have devastating psychological, medical, and financial aftermaths. Worst of all, death may be the outcome.
Healthcare is considered a critical yet hazardous business because of its nature of care practice. It is integrated within complex systems, high-end technology, multidisciplinary care providers, and sick patients. Errors or failures often lead to loss of life; healthcare is categorised as a safety-critical industry. It is estimated that the risk of dying while flying in an airplane is 1 in 3 million. In comparison, 1 in 300 dies of preventable deaths to a preventable medical accidents while receiving care. Hence, the World Health Organisation (WHO) announced patient safety is a serious global public health concern.

Global scenario
The WHO estimates one in 10 persons receiving healthcare suffer preventable harm. Each year, in low- and middle-income countries (LMICs), 134 million adverse events occur in hospitals and due to unsafe care, resulting in 2.6 million deaths (2018). Globally, it is estimated that medical errors kill more people than HIV, malaria, and tuberculosis, combined.

Patient safety is the averting of an unintended or unexpected harm to people during the provision of health care. Therefore, patient safety revolves around mitigating medical errors, limiting or circumventing harm, and decreasing the likeliness of mistakes through planning and coordination that fosters communication, lowers infection rates, and reduces errors.

A lack of resources or failure of professional compassion is not necessarily reasons for medical errors and deficiencies in the quality of care but such deficiencies and errors arise due to gaps in the whole system and the inability of organisations to adapt to changes. Hence, health systems need to adapt to all different functions and activities to deliver safe and high-quality care. It is a known fact that even the best health system is not free of the occurrence of medical errors and harm to patients.

In recent years, there has been increased interest in involving the public to enhance the quality of care and improve the patient experience in a hospital with an aim to increase their trust in the health system. Hundreds of millions of people in the developing world are affected by healthcare-associated infection around the world and is considered one of the critical issues in patient safety. Resource constraints, overburden, and inter-professional relationships are issues that affect patient safety in developing countries. At the same level, shortages of health expertise, advanced equipment, and poor integration of health information technology not only affects quality healthcare delivery in the developing countries but also puts care center at risk of getting blamed for poor outcome.

The incorporation of evidence-based clinical practice into patient care must be scaled up to tackle patient harm in resource-limited settings. The higher risk of nosocomial infections, medication errors, poor quality of maternal and perinatal care as well as resistance to an overall improvement in patient safety practices are concerns for poor patient safety and quality of care in developing countries, particularly in Southeast Asia.

Healthcare policymakers lack sufficient resources to implement better care practices at different levels of healthcare settings. Lack of logistics and supplies to control and prevent healthcare-associated infections, lack of infection control guidelines, medication errors, poor compliance with hand hygiene, blood safety, hospital waste disposal, and lack of coordination among multidisciplinary professionals are usually responsible for poor patient safety and unintended harm in developing countries.

Improvement in patient safety in resource-limited countries warrants prioritising goals with proper utilisation of available resources. There has been plenty of knowledge developed over the past few decades regarding tools, techniques, interventions, and best practices for better healthcare delivery. Continuing professional education, better professional relationship, accountability, and proper communication are critical for the improvement of patient safety. For better patient safety, priority should be shifted from productivity to teamwork, standardisation, and simplification of procedure. However, health systems are often operated in an environment greatly influenced by social, political, cultural, and institutional factors.

A culture of continuous learning from the past is crucial for improving patient safety. Therefore, organisations should develop a framework for incorporating improvement based on past experience in order to lessen future risks. The WHO has developed the Patient Safety Curriculum Guide for Medical Schools and recommended it to be incorporated in all countries around the world. A similar curriculum needs to be developed for pharmacy and nursing schools in order to mitigate risks for possible harm to the patients. At the same time, training and programmes should be developed for providers at different levels of healthcare delivery.

Better communication between patients and healthcare staffs plays a crucial role in the improvement of patient safety in developing countries. Therefore, the involvement of patients and their family members should be encouraged to participate in the healthcare delivery process. Moreover, patients are a great source of information while developing policies and practice guidelines for care.

Role of technology
Nowadays, technology is playing an increasing role in better healthcare delivery. Electronic medical records help manage patients’ records and treatment. Web-based systems have been developed for recording adverse drug reactions and medication errors. Increasing the use of electronic devices in intensive care units, emergency rooms, and other critical areas have resulted in a decrease in the incidence of harm. Thus, it is time for the developing countries to invest in healthcare technology for better patient safety and quality of care.

Medical errors can and will happen as to err is human. The developing countries need to adopt a holistic approach for quality care with a strong political commitment. An only integrated approach can improve patient safety and policy for continuous improvement. Therefore, continuous learning, and robust reporting should be encouraged. After all, patients must be placed at the centre of the healthcare delivery process.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)