By Virginia Wangui
NAIROBI, Kenya, Mar 22 – Many awareness days and weeks have been observed for specific health conditions. There are also those geared toward healthcare safety. The week of the 12th to the 18th of March 2023 was designated for the Patient Safety Awareness Week (PSAW), which is observed annually. This is an initiative of the Institute for Healthcare Improvement (IHI) aimed at encouraging everyone to learn about healthcare safety. Healthcare organizations observe it in accordance with the theme provided, in the style of the healthcare organization’s choice.
The purpose of this article is to highlight significant historical initiatives that have shaped today’s advances toward better healthcare systems. As a result, one cannot overemphasize this year’s theme and the call to improve healthcare system safety for patients and the workforce (care teams), as they are at the heart of the healthcare system, and the organization and environment are at the system’s periphery. Previous initiatives made an important contribution to improving the safety of the healthcare system by and for patients and workers. The big change occurred at the turn of the century.
This was accomplished through the landmark research work “To Err Is Human”; published as a book in 1999 by the former Institute of Medicine (IOM), now the National Academy of Medicine, which provided evidence on the gaps/challenges in the United States’ healthcare system. It laid the groundwork for the discussions that resulted in the current century’s advancements in healthcare safety. The publication aimed to create a more secure healthcare system. One of their findings showed that people believed the healthcare industry was safer than the airline industry. However, using data, they revealed that flying was far safer than dealing with the healthcare system. The number of people dying from adverse events in the healthcare system was compared to a jumbo jet crashing every day for a year. Notably, unlike the healthcare system, the airline industry had received immense attention by that point, which helped
them improve their safety processes.
The ideas for improvement came in the form of a second book, “Crossing the Quality Chasm,”; published by the same organization. They made recommendations that, if implemented, would have a significant impact on improving healthcare system safety. They emphasized the importance of improving leadership and direction, recognizing that organizational leadership buy-in would be critical in implementing these recommendations. Additionally, the six aims of improvement, the well-known six dimensions of quality, abbreviated by the acronym STEEEP, were recommended.
These were as follows: Safety – which entails preventing harm to patients and staff during the care process and from the care environment, avoiding unnecessary delays, Effectiveness is defined as the application of evidence-based recommendations to achieve the best treatment and care outcomes. Equity means avoiding any form of discrimination in the quality of care provided, Efficiency means avoiding resource waste, and Patient-Centered Care means enabling and empowering patients as partners in care. In addition, the book suggested a process for monitoring and evaluating the six goals.
With advancements, there are many available patient safety guidelines that have adopted the IOM’s recommendations for improvement in their structure and can be used by healthcare systems today. The specifics of these standards address issues such as improving the safety culture, improving the HR processes for staffing, improving communication and technology use, and the need for healthcare staff to commit to lifelong learning.
There are critical emerging challenges to workplace safety, such as workplace violence and mental health, that must be adequately addressed in addition to the improvements described in previous recommendations. These have received attention as standard issues that can guide the healthcare system in the respective prevention and improvement.
In summary, there is evidence of challenges in healthcare systems, and we (in the Kenyan healthcare systems) are not unique in these challenges, and solutions have been provided. If anything, we may be in a worse state because the evidence provided was from US healthcare systems, based on the fact that we are in the Global South. The burden remains in extrapolating the findings to our settings, implementing the recommendations made (or, better yet, developing different homegrown solutions unique to our challenges), and ongoing monitoring and evaluation. This is in recognition of the milestones reached by various organizations in Kenya to improve the safety of their healthcare system through standardization.
These efforts also include work done to provide guidelines and standards, such as the Kenya Quality Model for Health by MOH, the WHO Global Patient Safety Action Plan, ISO standards for healthcare, the JCI Standards, and so on. Adopting an existing evidence-based safety guideline may be a better way to establish a benchmark for improving healthcare system’s safety.
Virginia Wangui is Quality and Safety Manager, Gertrude’s Children’s Hospital
