Department of Quality of Care and Patients Safety
- Technical cooperation
- Collaborative Forum in Hospital Quality and Safety
Healthcare quality has been a distinct discipline for more than 100 years. Throughout the last century, several initiatives have proved that healthcare practitioners are concerned about the quality of care they provide to their patients, but, unfortunately, their concern is not enough to change the reality of health systems.
Although this concern is not a new phenomenon, a series of events has caused quality and safety to capture everybody’s attention, especially in developed countries.
Discipline chronology, from its origin to date:
- For 20 years, epidemiological evaluations have described the frequency and the risk factors associated to preventable adverse events. The first study was published in 1990 and was titled Malpractice Study.(1)
- Later, several studies conducted in different develop countries found similar results. For this reason, the international public opinion became more interested in quality of care. (2)
- In 1999, the American Institute of Medicine published a report titled “To err is human”, which has become a building block to spread information about preventable adverse events. Said report described the economic impact of healthcare safety failures. In addition to this, the report mentioned for the first time that between 48,000 and 96,000 people die every year due to different types of errors.
In October 2004, the World Health Organization (WHO) launched the World Alliance for Patient Safety, whose objective is to coordinate, promote, and improve patient safety worldwide. This Alliance fosters international collaboration and the adoption of guidelines among member countries, the WHO, technical experts, consumers, professionals, and industry groups.
Thus, special emphasis has been finally placed on patient safety globally.
– The WHO has also launched the Patients’ Initiative for Patient Safety, whereby patients can collaborate with health systems to prevent the reiteration of adverse events suffered (or not) by them.
The existence of this initiative indicates that society is becoming more and more concerned about the impact of safety failures and they demand the reduction of failure frequency.
- Between 2004 and 2006 the Institute for Health Care Improvement developed the “100,000 lives campaign”, which managed to reduce mortality rates in American hospitals by approximately 126,000 cases.
This campaign that revolutionized American healthcare centers required the implementation of evidence-based interventions.
Some of those interventions are: to prevent ventilator-associated infections, CVC-related infections, and surgical wounds; evidence-based care for acute myocardial infarction; the safe use of high-alert medication, and the implementation of rapid response teams for emergencies during hospitalization.
The “100,000 lives campaign” was later supplemented with another campaign, “5M lives”, aimed at preventing five million incidents of medical harm.
Although during the last century we had major medical breakthroughs (especially during the last years), many problems have arisen. Among these problems, we can highlight the occurrence of adverse effects suffered by patients supposedly receiving good quality care.
As healthcare professionals, we must work to change this situation.
Brennan TA, Leape LL, Laird N et al. Incidence of adverse events and negligence in hospitalised patients: results of the Harvard Medical Practice Study. New England Journal of Medicine, 1991, 324 (6):370-7.
2) Leape LL, Brennan TA, Laird N et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. New England Journal of Medicine, 1991, 324 (6):377-84.
The issue of Quality
In developed countries, it is estimated that one out of ten hospitalized patients suffers damages derived from medical negligence. In the developing world—where health resources are limited—these figures are probably higher, though, unfortunately, there are no studies to prove it, because the frequency of preventable errors or adverse events has only been measured by developed countries.
These errors include, for example, over 90,000 deaths per year, in the United States, and account for 3% of the budget allocated to health in that country.
Detecting the problem led many countries to start working for the reduction of adverse effects, but neither developed nor developing countries have made much progress on this field.
Patients are not the only victims of medical negligence. Healthcare professionals are many times regarded as secondary victims.
Patient safety is closely linked to reliability. This concept entails the patient will receive the tests, drugs, information, and procedures he or she needs at the right time and in the right way, according to his or her treatment needs. Reality shows that errors derived from conducting procedures incorrectly reach 3 per mil, while errors of omission may reach 3 per cent.
80% of medical errors derive from health system problems. Even well trained health professionals who work carefully are incapable of facing the complexity of current practice, and of avoiding errors and damages. The secret to avoid mistakes lies in the adequate assessment and design of processes aimed at error reduction.
This is why this quote from Sir Liam Donaldson, Chair of the Alliance for Patient Safety, always comes handy: “To err is human, to cover up is unforgivable, and to fail to learn is inexcusable”.