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Achievements in patient safety and barriers to achieving 100% safe health services



Table of Contents

Introduction. 3

Background: Patient safety. 3

Achievements made in patient safety. 5

Development of patient safety regulations. 5

Networked governance. 6

Advances in error reporting. 7

Creation of a culture of safety. 7

Reduced infections associated with healthcare. 8

Development of safety standards. 8

Use of IT systems. 8

Intensified teamwork in healthcare provision. 9

Advances in patient safety training. 9

Reduced medical resident fatigue. 10

Barriers to achieving 100% safe health services Barriers. 10

Lack of effective information-sharing. 10

Preference to internal regulatory strategies. 11

Shortage of staff. 12

Error-prone environment 12

Organisational cultures. 13

Conclusion. 13

References. 14


Over the last two decades, the desire for quality and safety improvement initiatives has prevailed in the health care industry. Quality health care refers to the extent to which the health services for populations and individuals increases the probability of desired health outcomes and are compatible with the existing professional knowledge. A recent study by Institute of Medicine (IOM) reiterated the need for pressurized efforts to ensure patient safety. Studies have showed that faulty medical processes and systems rather than the individuals cause majority of the medical errors (Hughes, 2008). These include inefficient and variable medical processes, the changeful mix of patients, variable provider experience and educational level, health insurance errors and several other factors contributing to the complexity of the healthcare. Additionally, to the present-day health care industry also functions at a much lower level than it is capacitated to provide effective, timely, efficient, equitable, patient-centred and most importantly safe health care (Hughes, 2008). Since errors result from the process and system failures, it is significant to adopt a range of process-improvement techniques that can identify ineffective and inefficient care and preventable errors and to influence changes related to the systems. Despite the existing errors, in the global health industry, developed nation such as Australia, United Kingdom and United States have made several advances over the last two decades. This paper examines the achievements that have been made towards improved patient safety in the last two decades. It also provides an analysis of the barriers to achieving 100% safe health services

Background: Patient safety

Patient safety comprises the processes involved in protection of patients from injuries resulting from medical mismanagement. Ensuring patient safety called for operational processes and systems that increased the likelihood of deterring adverse events (Fletcher, 2001). Developed nations are in endless pursuit of ways to improve the quality of healthcare in order to make it safer. Accidents and medical errors happen either through omission or commission, through system and process failures, as well as through nosocomial infections and iatrogenic infections (Graves et al., 2009; Reed & Kemmerly, 2009).

While there is no assurance on the exact number of the adverse events, estimates indicate that some 10 percent of patients worldwide experience some form of adverse events in hospitals while about 2 percent experience serious consequences (Braithwaite, 2005). Despite the fact that it is not clear the number of events that are preventable, it appears that the deaths reported in hospitals, which result from preventable events, exceed the death toll. This however does not suggest that the medical errors happen strictly in hospitals (Agrawal, 2009). In any case, there are not reliable statistics from other health care areas, such as dentistry, to support the assumption.

Despite the large scale of medical errors, certainty on the numbers of the adverse incidents is non-existent in Australian hospitals and overseas. Indeed, most studies have extrapolated national figures from small sample populations. Based on analysis of 14,000 medical records, a study by the Quality in Australian Health Care of the Healthcare System in 1995 showed that 18,000 Australians died each year. In which case, some 16 percent of the hospital admissions could be related to adverse events (Emslie et al. 2002). Therefore, assuming that some 25 percent of the deaths resulted from adverse medical error events can be prevented, nearly 4,500 preventable deaths estimated from the 1995 study correspond to 13 Jumbo jet crashes each year. Although the figures are disputable, the medical error toll definitely overcomes that of road carnage toll of 1634 as of 2003 (Australian Transport Safety Bureau 2003).  Studies done between 2000 and 2001 indicate that some 2 percent of the patients experienced severe effects while 10 percent of the patient experienced adverse events. This indicates large numbers given that an estimated 6.4 million hospital admissions were reported in Australia during the period (Roughead, 2008).

The healthcare systems have failed to guarantee safety of the patients because of the complexities in the healthcare system. Indeed, given the astonishing figures, the epidemiology of such silent epidemic has over the last one decade been examined with global figures indicating that some 10 percent of the patients will be harmed through preventable medical errors. Of these, 8 percent will die while 6 percent will suffer from permanent disabilities (Emslie et al. 2002).

Achievements made in patient safety

Development of patient safety regulations

Shift in regulations are among the most definite advances in promoting patient safety, specifically fuelled by the rise of private entrepreneurs in addition to the introduction of market mechanisms in the public sector. Among the developments include that of creation of regulatory bodies that seek conciliatory, devolved and participatory regulations, while at the same time sustaining traditional administrative methods such as inspections (Emslie et al. 2002).

Development of regulations over the last two decades has marked major advancements in the promotion of patient safety. In reaction to the mounting pressures on the need to address medical errors over the last two decades, recent years have witnessed proliferation of regulatory strategies and actors. For instance, Australia has the Australian Council for Safety and Quality in Health Care (2000), the US established the National Quality Forum, the UK has the Healthcare Commission, and Canada has the Canadian Patient Safety Institute.

A major shift has been noted in seeking the best way to ensure better and safer health care. While a larger bulk of the efforts has been channelled towards ensuring quality improvement, the patient safety issues still dominate the greater reform forum. At the same time, the control of abatement of risks to the communities as a key purpose has also emerged as the focus of these regulations. Advances have been seen in the approach to these regulations (Roughead, 2008). While the medical professional has traditionally been based on self-regulation, such a complacent approach is today being challenged by the growing regulatory bodies globally. Additionally, there is also interest in adopting external regulatory levers aimed at improving performance within the organisations, instead of assuming that such remedies should be left solely to voluntary behaviour change on the part of individual physicians, to ensure safe processes and systems.

Networked governance

Among the achievements in patient safety include networked governance of healthcare to promote patient safety. Government capacities have evolved in a range of directions. Today, the strategic planning performed by government departments takes consideration of the plans of various governmental and private sector players’ interests in order to ensure that their concerns on patient safety are considered (Roughead, 2008).

This however does not point to the idea of State Health Department or Commonwealth government aiming to wield power it is not mandated. Networked governance has achieved meaningful planning of healthcare provision by taking into consideration different other levels of the government, the hospital industry as well as pharmaceutical industry. This approach has been pursued by the Australian Council for Safety and Quality in Health Care, which the Australian Government Health Minister established in 2000 (Emslie et al. 2002). The Council functions through networked governance to gather different actors in healthcare provision to promote patient safety. The concept of networked governance is essentially suitable for pluralist health sector, such as that of Australia with multiple interest groups.

Advances in error reporting

Several achievements have been made in reporting of errors. Reporting of events and standardised collection of data yields crucial data that is applied in medical practices to promote patient safety (Duguid, 2012). In Australia, this has been facilitated through federal efforts in creating patient safety organisations (PSOs) that are authorised to receive and review patient safety data, while at the same time engaging healthcare providers to improve healthcare delivery, without the fear of legal consequences (Clancy, 2009). Australian Council for Safety and Quality in Health Care also works to detect the safety and quality issues from the patient records. This has improved the ability of the government to monitor whether its objectives of ensuring safe healthcare is met.

Creation of a culture of safety

Australian Council for Safety and Quality in Health Care has managed to reinforce a culture of safety among nursing homes, hospitals and medical offices in monitoring, evaluating and improving patient safety performance in Australia. In the United States, the AHRQ has reiterated the need for healthcare providers to use its suit of patient safety culture survey. The tool offers a baseline for organisations to monitor changes over time and to assess the patient safety intervention impacts. At present, some 6000 hospitals have established a mechanism that allows them to share culture survey data. This allows these hospitals to compare the efforts they make and to improve in consistency with the date, from the better performing hospitals. At the same time, peer-reviewed web-based journal, patient safety developed through the tool, helps organisations to espouse a blame-free culture and to assist the physicians to learn from each other’s mistakes (Clancy, 2009).

Reduced infections associated with healthcare

Australian Council for Safety and Quality in Health Care supports the development of patient-safety checklist that has been proved to deter, costly and deadly central line-associated bloodstream infections by some 66 percent (Clancy, 2009). Such promoted interventions include compulsory hand-washing along with other sanitary activities that aid in significant and sustained infection reductions (Graves et al., 2009). At the same time, increased use of intensive toolkit that contains the checklist among other tools has helped hospitals to reduce the infections by 75 percent (Clancy, 2009).

Development of safety standards

The creation of the Safe and Quality Use of Medicine in Australia in the 1990s triggered the review of traditionally-accepted practices that surround medication administration and reconfigured research-based safe use of medicines. This has indeed led to the origination of the term medication administration er.............

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