Dear HIFA colleagues,
I attended the WHO webinar on Patient safety and NCDs today. It was really well put together with lead presentations moving into panel sessions. There were contributions from several big names including Dr Tedros and Sir Liam Donaldson.
Warm welcome to several participants who have joined us as a result.
I would like to note three exchanges I had with the experts 'behind the scenes' that help us understand what we are talking about when we discuss the burden of unsafe care. It's helpful for all of us to be clear about definitions, especially as we prepare for our HIFA Spotlight discussion 14-20 September. www.hifa.org/patientsafety
1. It was said that 1 in 10 patients suffer harm. I asked "Does 1 in 10 patients harmed refer to lifetime risk?" Expert Irina Papieva replied: "The “1 in 10 patients is harmed in health care” figure should not be interpreted as a lifetime risk. It is an estimate of the occurrence of patient harm during episodes of health care, historically derived largely from studies of hospital care/admission."
I said: "Thanks this is helpful, so are we talking about 1 in 10 patients are harmed per episode of illness, or perhaps per month or per year? The idea 'of episode of health care' implies that we might even be saying that 1 in 10 patients are harmed at each medical visit (which I presume is not the case)"
2. The first speaker Bill Wang noted that 3 million die due to unsafe care. I said: "It has been estimated that 6 million die due to poor quality care. All poor quality care can be described as unsafe care, so the actual number is 6 million and not 3 million?"
One of the experts replied: "Quality of care is the broader concept, and safety is one of its essential dimensions, alongside effectiveness, people-centredness, timeliness, equity, integration and efficiency. For example, a patient may receive treatment that is safe in the sense that it does not cause an adverse event, but it may be ineffective, delayed, inappropriate or not consistent with evidence-based practice - and this can still lead to poor outcomes or death.WHO estimates that more than 3 million deaths annually are associated with unsafe care, whereas estimates of deaths attributable to poor-quality care use a broader conceptual framework and different methodologies and populations."
To which I said: "It's interesting if we do not include "poor-quality care that leads to death" as an example of unsafe care. We could argue that all poor quality care that leads to death is by definition unsafe. This includes for example misdiagnosis and failure to follow evidence-informed practice"
3. I also asked: "Can we understand more what we mean by 1 in 6 patients with NCDs experience harm. How do we define this temporally - lifetime, per hear? And how do we define 'patient harm' - do we mean that the patient has suffered signficant consequences or does this include more mior cases?
Irina Papieva explained: WHO’s patient safety terminology defines harm as an “impairment of structure or function of the body and/or any deleterious effect arising therefrom,” including disease, injury, suffering, disability and death.
And Blerta Maliqi (who leads WHO's Patient Safety team) added: "For definitions, please see https://www.who.int/publications/i/item/WHO-IER-PSP-2010.2 "
I learned a lot, but one or two of the questions are not yet fully answered. Can anyone help?
Did you participate in today's webinar? If so, please share a few words by email to: hifa@hifaforums.org
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org