Health Europa attended the 6th Annual World Patient Safety, Science & Technology Summit, where global leaders Dr Tedros Adhanom Ghebreyesus and Bill Clinton weighed in on the whys and hows of patient safety.
What will it take to end preventable deaths in hospitals? This was the central question at the 6th Annual World Patient Safety, Science & Technology Summit, which Health Europa attended in London in February.
The summit is the brainchild of Masimo founder and CEO Joe Kiani, who launched the Patient Safety Movement Foundation in 2012 in a bid to reduce the number of avoidable deaths in US hospitals to zero by 2020 (0X2020).
Over the years, the summit has proved an invaluable platform for hospital leaders, patient advocates, policymakers, and the healthcare industry to come together to exchange knowledge, share good practice, and discuss concrete measures to avert medical errors and preventable harm.
It has also attracted a host of big names, from Joe Biden, the former vice-president of the United States, to Jeremy Hunt, the UK secretary of state for health and social care – and this year’s summit was no exception, with keynote addresses by the likes of Dr Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, and Bill Clinton, the 42nd president of the United States, drawing packed crowds.
First, do no harm
The leading voice in global health, Tedros was elected to the top office of the WHO in 2017 and is committed to delivering a ‘world in which everyone can live healthy, productive lives, regardless of who they are or where they live’ – a goal which necessarily includes patient safety.
He began his address by highlighting the urgency of the challenge: “No one should be harmed while seeking care, [but] every year, millions of patients die or are injured because of unsafe and poor-quality healthcare.
“Adverse events are now estimated to be the 14th leading cause of death and injury globally. That puts patient harm in the same league as tuberculosis and malaria.
“There are an estimated 421 million hospitalisations in the world every year, and, on average, one in ten of those results in adverse events.”
These figures are particularly alarming given that at least of half of adverse events could
Patient safety in the developing world
Tedros acknowledged that the frequency and severity of medical errors differ from country to country, being dependent on a nation’s resources and the capacity of its healthcare system. In a high-income country like the UK, which has been recognised as a global leader in patient safety, medical errors are less common than in disadvantaged communities, which are the hardest hit by poor-quality healthcare. In fact, some two-thirds of adverse events take place in low- and middle-income countries, which are the last to benefit from advances in medicine and simultaneously the most likely to suffer because of medical errors.
Not only does the occurrence of medical errors lead to the needless suffering of patients and their families, Tedros said, it also “erodes the most precious resource” in healthcare: trust.
He explained: “When people aren’t sure whether it is safe to seek care, they will cease to seek care. They will stay at home, where their condition will get worse, or they will infect others, creating a greater burden of disease and greater costs for the health system.”
Tedros highlighted as proof of this the West African Ebola epidemic in 2014 and 2015, which killed more than 11,000 people.
“Because of the perception that health services were unsafe – and in some cases they were unsafe – many of those infected chose to stay at home. This created pockets of disease that spread through communities, with tragic consequences.”
It is due to incidents like this that the World Health Organization advocates so passionately for universal health coverage and health security, the director general added – because “when health services are not available, or not affordable, or not safe, the conditions are ripe for disaster”.
The economics of patient safety
These disastrous conditions have not just a significant human impact but also a substantial economic cost. Adverse events account for approximately 15% of all hospital activity and expenditure, while the price of treating safety failures comes in at trillions of dollars every year.
“Let me put it simply,” said Tedros, “medical errors aren’t just bad medicine; they’re bad economics.
“The investments needed to improve patient safety pale into insignificance compared with the costs of harm.
“The question, therefore, is not whether we can afford the interventions that will keep patients safe. The question is whether we can afford the status quo.”
Medication Without Harm
Nowhere is this more true than in medication-related harm, which has been estimated at an annual global cost of $42bn.
The WHO is working hard to address this via its Medication Without Harm campaign, the latest of three ‘global patient safety challenges’ which also target hand hygiene and surgical safety. The campaign has the ambitious objective of reducing severe, avoidable medication-related harm by 50% over five years.
It is working toward this in two ways:
- By improving the way medicines are prescribed, distributed, administered and consumed; and
- By increasing patient awareness about the risks associated with the improper use of medication.
In both instances, this comes down to a simple policy of ‘know, check, ask’. Tedros elaborated: “Patients must know their medication, check that it’s the right dose, and ask their health provider if they are unsure. Health providers must also know their medication, check that they have the right drug, at the right dose, for the right patient, at the right time, and ask the patient if they understand.”
The WHO is also supporting countries in their efforts to reduce medication errors by:
- Publishing guidelines to reduce harm caused by high-risk medicines and situations, patients who take more than one medication, and transitions of care, which commonly results in mistakes;
- Creating tools to inform patients about the risks and empower them to play a more active role in their own care;
- Developing a medication safety curriculum for the education of healthcare professionals; and
- Identifying research priorities to engage academic and research institutions.
These measures are especially important given the rise of antimicrobial resistance, Tedros added, noting that antibiotics being wrongly prescribed or taken incorrectly endangers the health of everyone.
The five steps to patient safety
Moving away from the WHO itself, the director general then turned his attention to the individual measures that health systems can themselves take to create an environment that promotes safety and minimises error:
- Committed leadership: Nationally and at the level of individual healthcare facilities, leaders are needed who will create a culture that puts patient safety at the heart of clinical care;
- Clear policies: The best evidence-based practices for keeping patients safe must be known and understood by all health workers. This should include clear policies on reporting and learning from medical errors, and how to respond to them should they happen. To this end, health facilities should promote an open culture that increases the incentives for reporting patient harm and medical errors and does away with the incentives for hiding them;
- Data-driven improvements: Robust data systems should be employed to track what’s working and what isn’t in order to promote learning and continuous improvement;
- Competent and compassionate health professionals in sufficient numbers: Medical errors are often the result of overworked, tired health workers, overcrowded healthcare facilities, staff shortages, poor training, and incorrect information being given to patients – it is therefore imperative that all health workers are provided with the necessary conditions, skills, training and tools to do their jobs to the best of their ability; and
- People-centred care: Instead of being passive recipients of their own care, patients should be empowered to play an active role in their health in order to reduce the likelihood of an error being made and harm caused.
The importance of collaboration
Implementing these measures is not a task one individual or organisation can undertake alone; it will require the collective effort of a range of stakeholders, from patient advocates to hospital executives and policymakers.
Drawing his presentation to a close, Tedros urged leaders in the audience to effect change to save lives and prevent needless suffering; he called on those in industry to use innovation to develop technologies and tools that make healthcare safer and more cost-effective; and he challenged people who run hospitals to establish a positive safety culture by dismantling the structures that discourage reporting and establishing multidisciplinary teams that deliver safe, people-centred care.
“Those of you in government can put in place clear policies, based on the best evidence, to reduce the risk of harm, prevent adverse events and errors, and ensure that when they do happen, they are reported in a blame-free culture,” he added. “Those of you who are advocates can continue using your voices to raise awareness of these issue and to keep us all accountable.
“Everyone has a role to play.” Patient safety – a common challenge and shared opportunity
This message was echoed by Clinton, who has been an enthusiastic supporter of the Patient Safety Movement since its inception and today serves as the foundation’s global chair of regional networks.
Like the director general before him, Clinton was keen to urge the movement to expand its reach to developing countries and also to highlight the importance of co-operating with the others if the target of zero preventable deaths is to be met.
“The best way to solve problems is with diverse partnerships of co-operations toward a common goal,” he said. “The fact that the politics and much of the economics of the world may be drifting away from the model embodied in the Patient Safety Movement should seal your determination to stay with what you are doing, not weaken it. We all know that co-operation works better than conflict.”
He continued: “One of the most influential books on me in the last decade is the first of the trilogy of [Edward O] Wilson’s latest books on human existence [The Insect Societies] in which he said that ants, termites, bees and people are the most successful species ever to live because they are the greatest co-operators.
“This is not rocket science. People have great advantages and disadvantages rooted in the fact that they have consciousness and a conscience. Our consciousness can sometimes make us think that we are smarter than we are, and our conscience can sometimes play games on us and convince us that we are righteous when, in fact, we are flawed, but we have the capacity to go beyond – unlike ants, termites and bees – our own kind to deal with whole new challenges, and that’s essentially what you are doing.
“You are proving that, over the long run, the 21st Century, if it is to be the most prosperous and peaceful time in human history, will have to be a century in which diverse groups reach across lines that superficially divide them to meet common challenges and seek shared opportunities, and, therefore, you are not only saving the lives that are before you, you may be saving the democratic enterprise, and you may be saving a belief in the possibility of progress, and I think it is really, really important.”
The gift of one more day
Clinton went on to share with the audience the personal revelation that has shaped his continued commitment to the 0X2020 goal: in 2017, he became the oldest person in his family in three generations. What does this have to do with patient safety?
“Every day is a gift to me, and I also have lived long enough now to know that in almost every endeavour there are no permanent victories or permanent defeats. All there is the permanent gift of choice and life – to try,” he explained.
“From the perspective I now occupy, since we are in London I can say that every passing year convinces me that the great English poet Wordsworth was right when he said that the last best hope of a good person’s life are the little unremembered acts of kindness and love, the things that we can all share are the things that matter most, and all of our university degrees and all of our advanced learning and all of our skills and all of the whatever else we do gain more meaning when we give the simple gift of one more day to other people.”
With that, Clinton expressed his desire for the Patient Safety Movement to not just regionalise but also broaden its scope to include low- and middle-income countries, as well. “If this movement can spread … into the developing world, God only knows what these people whose lives you have saved may accomplish in their lives,” he said.
Why plan for zero?
Clinton then urged his audience not to be discouraged and – perhaps more importantly – not to think of the lives being saved as mere numbers or costs cut but as humans with hopes and ambitions.
“You should keep score because underneath the score there is something the dimension of which you cannot imagine,” he said. “We know in the US it probably cost us $30bn a year to have all these people die when they shouldn’t, and that’s all really important, but that’s not why you should [plan for zero].
“You should do it so one more person can find out whether there’s Life in the Universe … You should do it because there is a child somewhere whose claim to grow up, love Nature, fall in love, have children is no less than your own. You should do it because you made a choice, all of you, one way or the other, to save and enhance lives, or you wouldn’t be here, and when you are in that space, you have to accept the fact that you won’t always succeed, that you may make a mistake, that circumstances may intervene beyond your own control, but every single day you can get better at what you are doing.”
He pointed to Joe Kiani as proof of this – not content with founding and heading the global medical technology company Masimo, Kiani set out to reduce the number of preventable deaths in hospitals after the release of the 1999 report ‘To Err is Human: Building a Safer Health System’, which, for the first time, quantified the impact and consequences of medical errors in US hospitals.
Kiani “concluded that this was a problem we could whip, that it would be cheaper than brain surgery per person, or complicated cancer surgery, or putting people back together after a horrible car accident, or dealing with the consequences of explosive devices on battlefields,” Clinton said, “that if we did it right, we could probably save more lives for less money and less time than most of the things that we are organised to do, and that a big challenge in every human life is making sure you are organised to deal with the areas of greatest opportunity as well as the areas of greatest problem.
“It is a noble good thing, and there is plenty more still to do.”
Indeed, the fight to reduce preventable deaths to zero is far from over, but with the support of such influential figures as Tedros and Clinton, the Patient Safety Movement is well on its way to delivering on what Clinton called the “simplest and most profound of all opportunities” and giving the “simple gift of one more day to other people”.
This article will appear in issue 5 of Health Europa Quarterly, which will be published in May.