The provided sources detail global efforts and challenges in building high-reliability health systems and organizations that consistently protect patients from harm. These systems are designed to operate safely not only under normal conditions but also to be resilient in the face of errors, emphasizing rapid recovery and reinstatement of safety protocols. The focus is on anticipating challenges, diligently monitoring operations through data, and learning from both successes and failures.
The overarching goal is addressed through five strategic objectives:
- Transparency, openness, and no blame culture (Strategy 2.1): This strategy is recognized as crucial for patient safety. A positive safety culture is characterized by mutual trust, shared safety perceptions, and confidence in preventive measures, moving away from blame towards learning from errors, sometimes referred to as a “just culture”.
- Current Status: Only about a quarter of countries report efforts towards developing a safety culture. Globally, approximately 23% of countries conduct periodic safety culture surveys.
- Key Initiatives: Essential components include well-defined procedures and reporting systems for “never” or “sentinel” events—serious medical errors or unexpected occurrences resulting in significant harm. While 38% of countries have operational reporting systems, 44% have defined events but not yet operationalized the system. Efforts also involve implementing “no blame” policies (around 25% of countries) and “just culture” (17% of countries) to encourage reporting without fear of punishment.
- Examples: Countries like Thailand, Liberia, Uganda, Sri Lanka, Singapore, Malaysia, Türkiye, the United Kingdom, Argentina, Poland, and Belgium employ various approaches to monitor and improve their safety culture, including annual surveys and organizational assessments. National reporting mechanisms for never/sentinel events are seen in countries like Australia, Canada, Chile, and the Netherlands, often utilizing electronic platforms or even toll-free lines. The SingHealth Duke-National University of Singapore Institute for Patient Safety and Quality (IPSQ) has developed initiatives like TeamSPEAK™ to promote psychological safety and a “speaking up” culture, emphasizing staff well-being alongside patient safety.
- Good governance for the health care system (Strategy 2.2): This involves establishing dedicated teams of patient safety experts at national and local levels to coordinate, implement, and monitor patient safety activities.
- Current Status: About 38% of countries have fully functional patient safety institutional frameworks established through policies or legislation, while 46% are developing them. Globally, 52% of countries have designated a national patient safety officer, and 51% have established a national patient safety body. There remains a significant gap at the subnational level.
- Key Initiatives: The Global Patient Safety Action Plan 2021–2030 advocates for national patient safety officers and coordination bodies. Patient safety is often integrated with other domains like clinical governance, quality of care, and accreditation programs.
- Examples: The Saudi Patient Safety Center (SPSC) utilizes hospital patient safety culture surveys to support hospitals in identifying areas for improvement, providing workshops, and developing an online platform for collaborative learning. They are also working to amend laws hindering a fair and just culture.
- Leadership capacity for clinical and managerial functions (Strategy 2.3): This strategy focuses on cultivating robust leadership that promotes a “safety first” mindset, champions continuous learning, and streamlines strategies.
- Current Status: Despite its importance, there is a notable lack of emphasis on leadership capacity-building, with only 26% of survey participants indicating it has been prioritized. Only 9% of countries have a specific center for fostering such leadership skills, and 19% have active programs dedicated to it. Programs for early-career professionals are particularly lacking, with only 9% noting their existence.
- Examples: Countries like Afghanistan, Canada, Qatar, Cuba, Lebanon, Australia, and Ireland are making strides in enhancing patient safety leadership through WHO-supported programs, non-governmental organizations, national health strategies, and specialized training institutes. The NHS Patient Safety Strategy in the United Kingdom emphasizes the designation of patient safety specialists.
- Human factors/ergonomics for health systems resilience (Strategy 2.4): This interdisciplinary approach aims to enhance human well-being and system efficiency by improving the interface between humans and technology, considering human behaviors, capabilities, and constraints.
- Current Status: Only around a quarter of countries have started to apply human factors principles in patient safety interventions. Globally, only about 9% of countries consult with human factors experts.
- Key Initiatives: Expert groups and academic programs are essential to guide the selection, application, and evaluation of medical equipment and technology, as well as the design of related tasks and procedures.
- Examples: Canada has a network for human factors in healthcare. Singapore’s Ministry of Health integrates human factors into its root cause analysis. Sweden has a national council focusing on human factors. Denmark, Georgia, and Poland integrate human factors methodologies to enhance the safety of medical devices and IT systems. Ireland and the United Kingdom offer advanced academic programs and embed human factors into health care systems and device design.
- Infrastructure Safety: Ensuring both structural safety (e.g., building integrity, resilience to disasters) and non-structural safety (e.g., essential access pathways, critical systems, medical equipment) in hospitals is crucial. While 85% of countries have defined structural safety standards, only 42% effectively enforce them. A similar pattern is observed for non-structural safety.
- Patient safety in emergencies and settings of extreme adversity (Strategy 2.5): This strategy focuses on integrating patient safety elements into health emergency preparedness, response, and recovery plans.
- Current Status: The COVID-19 pandemic highlighted the fragility of health systems, leading to increased healthcare-associated infections (HCAIs), medication errors, and diagnostic mistakes. About 30% of countries have successfully incorporated patient safety into their health emergency strategies, with an additional 50% actively working towards this integration.
- Key Initiatives: A proactive and systematic approach to managing patient safety risks involves meticulous identification, examination, and mitigation of hazards. Only a quarter of surveyed countries have established risk registers and risk mitigation strategies, and a similar percentage (25%) regularly conduct practice drills and response rehearsals.
- Examples: Countries like Bhutan, India, Namibia, Liberia, Azerbaijan, Cameroon, Malaysia, Chile, and Uruguay demonstrate various approaches to address threats, including comprehensive contingency plans, systematic threat identification, and regular mock drills.
Overall, the sources provide a comprehensive snapshot of the diverse progress across countries in establishing high-reliability health systems. While there has been significant progress in some areas, particularly in establishing structural elements like national patient safety officers and bodies, process-oriented initiatives such as leadership capacity building, human factors integration, regular emergency drills, and comprehensive safety culture assessments often lag behind. This highlights a critical need for targeted interventions and resource allocation to strengthen these process criteria to build truly high-reliability and safe health systems globally.
Reference: Global patient safety report 2024. Geneva: World Health Organization; 2024
