[Re: https://www.hifa.org/dgroups-rss/spotlight-patient-safety-and-ncds-22-in... ]
Dear HIFA Colleagues
Neil suggested I say a bit more about understanding and improving safety in low-resource settings (Aim 3). Clearly increasing resources is the most important long-term objective. However, it is also possible to improve the safety and quality of care using some methods that are applicable to any healthcare setting, indeed to any safety-critical industry. My own approach would be to focus on the safety of care in the first instance essentially targeting care that is very poor quality or even dangerous and which may leave patients in a worse state than before they entered treatment.
Many well-intentioned interventions do not gain traction because they do not give enough attention to initial 'system diagnosis', which is discovering the strengths and weaknesses of the existing system. Sending donations of equipment into a setting for instance will fail if there is no capacity for maintenance of that equipment. Implementing guidelines from well-resourced systems may simply put impossible strain on a lower resource setting.
There are a variety of techniques that can be used to assess the system. These include process mapping, incident analysis, interviews, observation and ethnography. These are research methods, but can be used in a simpler form to make a rapid assessment of strengths and weaknesses. This is a very revealing process even for experienced clinicians who may have worked in the setting for a long time.
There are also a range of approaches to improving safety. Targeting critical safety processes, like hand washing and patient identification, may be a good first step leading on to wider changes to the system, such as through improved communication and organisation of teams. Some risks can be controlled by restricting the care that is provided, limiting the use of complex techniques that cannot be managed in the setting.
Some Oxford and Kenyan colleagues and I made an initial attempt to summarise these approaches in these open access publications. Each of the papers has references to useful practical resources
https://adc.bmj.com/content/106/4/326
https://adc.bmj.com/content/106/4/333.abstract
This is also a really useful short paper led by Albert Wu about using low-tech solutions to cope with safety issues in low-resource settings. Doing more with less.
https://journals.sagepub.com/doi/full/10.1177/25160435261445192
I hope these papers and links might be of some help to HIFA colleagues. There are many more available. Health Information must of course focus on providing up to date and relevant information on clinical issues. However, we also need to share information about improving health systems if we are to improve the safety of care.
Best wishes
Charles
HIFA profile: Charles Vincent trained as a clinical psychologist and worked in the British NHS for several years. Since 1985 he has focused on conducting research on the causes of harm to patients, the consequences for patients and staff, and methods of improving the safety of healthcare. charles.vincent AT psy.ox.ac.uk