Patient safety and quality in healthcare

Abstract

Globally, health systems face constraints and challenges around patient safety and quality, lack of human resources, and rising moral distress among nurses. This concern about the gap in quality and patient safety and the need for improvement was highlighted more than a decade ago in two landmark studies by the Institute of Medicine (IOM): To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. These reports were followed by a staggering number of scholarly publications, improvement initiatives, and the establishment of various institutions on patient safety. In 2004, the World Alliance for Patient Safety was launched to advance the goal of patient safety, to coordinate patient safety initiatives globally, and to reduce the impact of unsafe healthcare through a number of systemic programs (e.g. mobilizing patients and organizations for patient safety, addressing taxonomy, research, development, and reporting of learning systems). Additionally, an ad hoc expert group of the Alliance produced a report summarizing the evidence on patient safety, which highlighted structural, process, and outcome gaps in need of further research (e.g. safety culture, organizational determinants, structural accountability, lack of patient involvement in patient safety, adverse events, injuries related to drug treatment, and medical devices). Furthermore, the report highlighted the burden in terms of morbidity and mortality posed by unsafe healthcare globally, lack of available data from developing countries around structural and process factors contributing to unsafe care, and the applicability of data derived predominantly from developed countries to local conditions in developing countries. Recommendations were made for a better understanding of the epidemiology of adverse events and processes contributing to them in developing countries. In nursing, the response from the profession to the call for patient safety and quality has been remarkable. In an evidence-based handbook for nurses, Hughes highlighted nursing’s contributions to patient safety and quality, evidence-based practice, patient-centered care, improvement in working conditions, and the work environment for nurses, and discussed a number of opportunities for further improvement and research. Furthermore, nurses’ continuing contributions span a broad range of initiatives in practice (e.g. patient advocacy and attentiveness training and nurse-led quality improvement), education (e.g. curriculum changes to target core competencies such as evidence-based practice, informatics, and quality improvement), and research using a number of conceptual and empirical methodologies to explicate, analyze, and synthesize data and to implement and evaluate interventions (e.g. nurse-led clinics, tele-health, and care pathways). In addition, nurse leaders and nursing governing bodies responded with a number of position papers, revision of policies and Code of Ethics, and accreditation and regulatory initiatives, to demonstrate the profession’s commitment to patient safety and quality. Although there has been some progress, more still needs to be done.