Hippocrates, the Greek physician, known as the father of medicine had famously said that the key approach in the practice of medicine has to be ‘Primum non nocere’ or ‘First, do no harm’. Doctors, nurses and health services attempt to achieve that goal; however, it is a fact that some people do get harmed while accessing health services, mostly inadvertently, and a proportion of those are preventable errors.
Patient safety
Safe care or patient safety is one of the key components of quality health services. It is considered amongst the most tangible components of healthcare quality and one that is directly linked to patients. Health services lose value if they are not of good quality in general and safe in particular. Thus, patient safety is all about the reduction of preventable harm associated with healthcare to an acceptable minimum.
It is widely recognised that on one hand, unsafe care erodes people’s trust in healthcare system services and alters their health-seeking behaviour. Unsafe care and reduced trust of people demotivates healthcare providers as well. Then, there is the very high cost of unsafe care which is estimated to be around 15 per cent of total health expenditure, globally. In fact, economists have argued that investing in making healthcare safe is a very cost-effective intervention.
It was in this backdrop that the 72nd World Health Assembly of the World Health Organisation in May 2019, designated September 17 as ‘World Patient Safety Day’ (WPSD). This is the most recent world day designated and approved by the WHO. The objectives of WPSD are to improve worldwide patient safety awareness, increase public participation in health-care safety and start dialogue amongst key stakeholders to make health services safe.
Safety of healthcare providers
The first WPSD in 2019 had the theme of ‘Patient Safety: A Global Health Priority’. The theme of WPSD 2020 was ‘Speak Up For Health Workers Safety!’, with the slogan ‘Safe Healthworkers, Safe Patients’. The WPSD2020 was dedicated to the millions of health workers fighting Covid-19 across the globe, many of whom themselves got infected and even died in their attempt to provide health services and save others.
The theme of WPSD2021 is ‘Safe Maternal And Newborn Care’ and the slogan is ‘Act Now For Safe And Respectful Childbirth!’. The theme underscores the need to prioritise and address safety in maternal and newborn care, particularly around the time of childbirth, when the most harm occurs. This theme is especially important in the context of disruption of health services due to the pandemic, which has further compounded the situation.
In the Covid pandemic, there is evidence that most non-Covid health services were disrupted as many health facilities were either re-purposed or closed and health workers were diverted to deliver more pressing health services for Covid-19. Though countries had made the effort to continue to provide essential health services, it was not always possible. Health services for pregnant women, newborns, lactating mothers and all children were variably affected.
Keeping moms and babies safe
The theme of WPSD 2021 is highly relevant, as globally, approximately 810 women die every day from preventable causes related to pregnancy and childbirth. In addition, around 6,700 newborns die every day, amounting to nearly half of all under-5 deaths. This is relevant for India as well, to re-examine and review the situation.
There is tremendous risk and harm that women and newborns face as a result of unsafe care and the situation needs to be given urgent attention in Covid-19 time. Fortunately, the majority of stillbirths, maternal and newborn deaths are avoidable through the provision of safe and quality care by skilled health professionals working in supportive environments.
Sometimes citizens see safe care as the role of the government and healthcare providers only. However, the reality is that if people have a better understanding of what makes healthcare safe and what harms are avoidable in health services, they can contribute to and demand better quality and safer healthcare from governments.
Simple measures
Similarly, for health facilities and providers, often it is not fully appreciated that every single action, no matter how big or small it is, can contribute to safe healthcare. Just to highlight, even minor actions at the facility level can contribute to better healthcare. One, if there are no wet floors and spillage of water on the floor, it could prevent patients (or relatives) from falling, which is a very common concern in hospital and health centres and is emerging as a major patient safety issue.
Second, the provision of running water and soap for handwashing closer to patient wards in hospitals and at every primary health centres could reduce infections and is more relevant in Covid-19 times.
Third, simplified standard treatment protocols and guidelines can reduce the unnecessary use of medical resources and prevent the development of antimicrobial resistance, another major challenge.
Fourth, every health facility should develop a plan for training its staff with the provision of regular in-service training in patient safety.
Fifth, a culture of reporting, discussing and learning from mistakes on patent safety needs to be developed at all facilities.
Health is a state subject in India; therefore, in addition to policy initiatives of the Union Government, the states need to take additional and concrete measures to improve patient safety. Each one of us needs to see World Patient Safety Day as a small step to achieve the bigger goal of health service. It is only possible with the coordinated actions of all stakeholders and on this day, we should all think about what we could do to make healthcare safe.
The writer is a medical doctor and epidemiologist. He is India’s leading vaccines, public policy and health systems expert and the co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic. He tweets at @DrLahariya and can be reached at: c.lahariya@gmail.com
