In 1999 the US Institute of Medicine published the ground-breaking report To Err is Human, highlighting the scale of medical errors and ensuing excess mortality, revealing the widespread concerns on patient safety and providing a roadmap for creating safer health systems.
Twenty years on, a significant milestone was reached this week as we celebrated the first-ever annual World Patient Safety Day on 17 September.
We have come a long way over the past two decades. The quality of medical care continues to improve with increased resourcing, advances in technology and continuous learning.
However, the struggle to safeguard patients’ health and survival continues across innumerable hospitals and clinics around the world, as low- and middle-income countries and communities lag behind in their access to safe and good-quality medical services.
Doctors may be bound by the sacred Hippocratic Oath – pledging to do no harm to their patients – and most countries have adopted robust legal frameworks to protect patient’s safety and rights, yet medical errors still occur, more frequently than one could imagine.
According to the World Health Organization (WHO), 4 out of every 10 patients receiving care at primary health facilities are harmed while seeking care; up to 80% of this harm is preventable.
Millions of medical incidents occur each year due to unsafe care in hospitals in low- and middle-income countries, contributing to 2.6 million preventable deaths.
Hundreds of millions of falsified and substandard medicines and commodities enter the global medical supply chain unchecked each year, compromising patient safety and resulting in avoidable harm to those seeking care.
Such high numbers of medical errors are alarming. But in fact, it is even more alarming when no errors or only very low numbers of them are being reported.
Health worker behaviours and practices are equally crucial in promoting safer care. Recent studies show that a considerable proportion of health workers think it is acceptable to hide clinical errors that did or could have harmed their patients.
Most errors can be attributed to systemic failures in adequately resourcing health systems and regulatory authorities, in particular in low- and middle-income countries. However, instead of focusing on blame, shame and punishment, what is needed is to promote and maintain a culture of safety and learning, – as highlighted in this informative paper on medical error prevention published earlier this year.
Understandably, given the resources and investment in health systems and behaviours, high-income countries have been leading from the front in inculcating a culture of patient safety, and developing countries seem to be catching up.
But remarkably, little or no evidence on patient safety is available from settings where patients are perhaps most vulnerable and potentially more prone to receiving unsafe and undignified medical care.
Millions of people affected by disasters and emergencies each year seek medical care from service-providers across a wide spectrum of agencies, contractors and non-state actors, typically in an insecure and unregulated environment.
Over the years, the international development sector has worked tirelessly to strengthen national health systems and improve quality of care at government health facilities, achieving remarkable outcomes, such as significant reduction in maternal and child mortality in Bangladesh and Ethiopia.
Similar rigour and emphasis is now needed to assure universally safe medical practices across all humanitarian settings globally.
Availability of sufficient resources – not just human but equipment, commodities and time – to provide life-saving services under stressful conditions in disaster zones and conflict settings is challenging enough.
But assuring medical safety and achieving minimum standards of clinical and pharmaceutical quality is the holy grail if the sector aims to comply with the core humanitarian principle of doing no harm.
Vulnerable children and communities deserve safe and dignified medical care. We’re already making efforts to make this a reality across all our medical programmes.
In addition to marking the first World Patient Safety Day, some remarkable progress has been made this year, with the global health cluster at WHO leading on efforts to strengthen the quality of care standards in emergencies.
Save the Children has been contributing to this process. As we celebrate 100 years of saving children’s lives, we are committing to significantly strengthen our medical service delivery, ensuring ALL children and carers receiving medical care provided by Save the Children globally are protected from harm and receive safe, good-quality care.
We are working closely with our strategic partners and across many networks, such as the Global Health Cluster, the Global Child Health Task Force, the Quality of Care Network and the Every Newborn Action Plan, to build coalitions and strengthen the quality of care children receive across international development and humanitarian programmes globally.
Last year, Save the Children supported medical services through 2,169 facilities across 23 countries globally and #PatientSafety is at the heart of our work.
We employed more than 450 medical staff globally, including paediatricians, obstetricians and gynaecologists, medical doctors, nurses, midwives, nutritionists, pharmacists, technicians and other qualified health workers, delivering care across a variety of settings including humanitarian responses in Colombia, Syria, Mozambique and Bangladesh.
We are accountable to children and the communities we serve. Accordingly, we are further strengthening our policy and regulatory frameworks to assure medical safety, while promoting a culture of learning to minimise medical incidents and maximise patient safety across our programmes.
To quote Kohn, It may be part of human nature to err, but it is also part of human nature to create solutions, find better alternatives, and meet the challenges ahead.
100 years on from Save the Children’s foundation, our commitment to safeguard children and saving children’s lives has never been stronger. As part of that, we are making sure our medical services remain safe for beneficiaries and safe for our staff.