[In response to guiding questions:
1. What is unsafe care and what is its local and global impact?
2. What are the main causes of unsafe care for people living with NCDs? To what extent is access to reliable healthcare information a determinant of patient safety?
3. What can be done to better understand and improve health systems for safer care for people living with NCDs?
4. How can we better support patients and primary and facility-based health workers to deliver safe care?]
Hi HIFA colleagues,
I apologize if this has come later than allowed given the excellent conclusions and summaries that have already come up. As I was having some technical difficulties accessing the full site, Dr. Cherian recommended sharing thoughts when I was back in good internet range, but regardless I'm excited to be part of this community.
Regarding guiding question #1: Wearing my different hats on surgical innovation and as a cardiologist, I've increasingly come to think that the infamous Anna Karenina quote regarding happy families is applicable here - all [safe care delivery systems] are alike [in ways that matter]; each [unsafe care delivery system] is unhappy in its own way. Safe care delivery aligns a drive for continuous improve and excellence with well-trained human resources, equipped with adequate physical and systems resources, supported by appropriate infrastructure and medical materiels, to delivery high-quality, low-variance, individualized care to patients who are active participants in their own health. Deviation along any of the pathways creates unsafe care. Our colleagues on this forum have shared beautifully on the local and global impact.
Regarding guiding question #2: NCDs are quite broad because chronic diseases and risk factors dominate much of the high and middle-income countries' (and, increasingly, lower incomes countries' too) dialogue; yet surgical conditions that could potentially be quite directly treatable and curable qualify too. One unifying thread is what I would call the "rusty scalpel" phenomenon. A colleague in the safe surgery space had posed the challenge: in environments where even having a rusty scalpel and someone willing/able to wield it is an expected "best case scenario", how does one get not only organizational and market but even patient buy-in to innovations to improve? I see this same phenomenon daily in cardiology too, though instead of rusty scalpel it's patients who are used to seeing their parents and grandparents having died early of cardiovascular disease if they haven't died of accidental trauma even earlier. Or it's fellow healthcare professionals resisting patient transfer to higher level of care for lifesaving therapies because with heart failure care advancing so rapidly, their idea of what's available to save patients and therefore which patients are viable candidates for advanced therapies haven't kept pace. Reliable healthcare information is the biggest tool to replace the rusty scalpel for patients, clinicians, and health system stakeholders alike.
Regarding guiding question #3 and 4: These are immense questions that our colleagues in this forum have striven to tackle in big systems ways at the level of Joint Commissions and WHO guidance resources, all the way to individual cases highlighting roles of communications, education, setup, and patient/provider navigation of the care delivery setting itself. The numbers of patients are immense when we talk about NCDs - Freihat et al 2025 estimated 12.4 billion incident cases and 43.8 million attributable death in 2021 alone, costing a staggering 1.73 billion DALYs - and, for most of the chronic conditions within this umbrella, each case is lifelong. That means the economics of the entirety of the care journey matter intimately to patients - witness the number of patients who stop taking blood pressure medications when they lose their jobs and can't afford medications, as just one example - and to systems thinking about delivery at scale - scale of patient epidemiology, but also of timeframes. This has meant in turn that on the innovation side of things, novel technologies and treatments have increasingly needed to be evaluated under the lens of real world evidence, over lots of time and in lots of patients. Researchers and regulatory pathways in different countries are still working to figure out how to do so, especially with the explosion of digital health technologies as well as use of unevenly regulated technologies such as AI and LLMs. On the care delivery side of things, longitudinal care management at the point of need is still the keystone of the whole system. Tracking outcomes and processes in efficient, low-burden ways; and optimizing NCD management without proportionately increasing healthcare human resource burden are both potentially two sides of a single digital transformation coin.
HIFA profile: Debbie Teodorescu is a Cardiologist/Founder of MultiCare Pulse Heart Institute/SurgiBox Inc, USA. Professional interests: NCD, SSI, research and innovation. dlteodor AT gmail.com