The Institute of Medicine (IOM) report To Err is Human in 1999 revealed that medical errors are responsible for 44,000-98,000 deaths per year in the U.S. More than two-thirds (70 per cent) of the adverse events found were thought to be preventable – technical errors (44 per cent), diagnosis (17 per cent), failure to prevent injury (12 per cent) and errors in the use of a drug (10 per cent).
Factors leading to errors are divided into systemic and personal factors. Systemic or environmental factors like complex working conditions, lack of leadership support, lack of personnel, overtime, information flow and workload are common factors related to medical and paramedical personnel exposing the healthcare system environment to life threatening errors at many points of the therapeutic process. Personal or human factors such as lack of teamwork, poor communication, carelessness, fatigue, and competing tasks have a negative impact on team performance thus affecting patient safety.
Today, preventable harm is placed among the leading causes of death in the United States (IOM report 2000). This is considered a public health crisis. Hence, health systems stakeholders should collaborate and take action to prevent the harm resulting from healthcare.
The National Patient Safety Foundation (NPSF) calls for coordinated efforts between leaders and policy makers to trigger a public health response to ensure safety for patients in healthcare systems and mitigate the risks of preventable harm. The below framework (Figure 1) is their proposal, which they recommend for adoption by healthcare systems to guide efforts and propagate effective actions.
Improving patient safety activities are so far individual initiatives taken by hospitals in a non-consistent approach leading to diversified outcomes.
Today it is time to call for a more organised, structured and national approach that starts at the top by engaging all policymakers, governments, insurers and healthcare leaders to establish the necessary infrastructure, ensure patients are not harmed by adverse events, establish a blameless reporting culture and set measures to prevent harm at all levels.
The situation of Patient Safety in a developing country such as Lebanon is worrisome because of the unreliable supply of equipment and medications, the lack of protocols for infection control and waste management, the shortage in human resource capital and the financial restrictions on the healthcare system and its employees.
The Lebanese Society for Quality & Safety in Healthcare (LSQSH) is working in collaboration with the World Health Organisation (WHO) to motivate all Lebanese stakeholders and establish a national patient safety programme guided by the above-mentioned framework aiming for standardised practices and reduction in harm.
A group of experts studied the most frequent events occurring in the patient’s path in a healthcare system from admission to hospitalisation ending by the discharge, taking into consideration the risks present in the environment and the impact of human and behavioural factors including communication. A set of patient safety goals was established for each part of the journey. For each goal, a set of indicators was defined, and a target was identified.
Assessment of the educational needs of the Lebanese community was done through a survey to study the knowledge of the population and see where we can interfere to increase awareness.
This study was conducted by the Lebanese American University (LAU) residents at two hospitals in Lebanon (one in Beirut, and one outside of it) where the survey was distributed to the Lebanese patients to assess their knowledge about their safety in hospitals.
Upon assessing for protocols related to hand hygiene, identification bracelet and marking the site of surgery, knowledge of those topics was suboptimal. Other protocols related to fall precautions and medication administration were very well known for the population. Although 76 per cent of the population knew about the protocols, only 32 per cent were willing to remind the providers about this protocol.
This discrepancy between knowledge and the willingness to participate in their safety reflects a possible sociocultural norm that influence the patients or visitors’ attitude and perception of the physician-patient relation.
Thus, awareness campaigns were directed towards educating the population about the importance of participating in implementing their own patient safety and ultimately work towards having patient safety an important element of patients’ rights.
The “Stay Safe” video and booklets were created and distributed within hospitals, scientific fairs, media announcements, social media and community educational activities… etc.
One year after community education and healthcare providers training, measurement of patient safety indicators was made available for hospitals. A pilot project was conducted with five hospitals aiming for a national and international benchmarking. Many challenges were encountered as unifying data collection tools and methods, anonymous reporting of the benchmarked results… etc.
Although Patient Safety measurement became a mandatory topic on the new Lebanese Standards for accreditation, today our work needs to be sustained with the support of policymakers, government, healthcare organisations, third party payers, professionals, patients and their families in order to maintain a national programme that encourages speaking up and error reporting while staying away from finger pointing. The ultimate goal being “Zero Preventable Harm for all Patients”.
A public health crisis? Yes. Each member of our society has a role in improving our healthcare system and in implementing the public health action plan.