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  • 'Mind the Implementation Gap': the challenges facing Ethiopia


    Yakob Seman Ahmed
    • Ethiopia
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    • Health and care staff, Patient safety leads

    Summary

    Yakob Seman Ahmed, former Director General for Medical services in Ethiopia and the chair of national patient safety task force, and a recent Humphrey fellow, Public Health Policy, at the Virginia Commonwealth University, reflects on Patient Safety Learning's recent report 'Mind the implementation gap: The persistence of avoidable harm in the NHS' and the similar challenges Ethiopia faces in implementing its own standards and policies.

    Content

    The recent Patient Safety Learning report, 'Mind the implementation gap: The persistence of avoidable harm in the NHS', highlights some important challenges and barriers to patient safety improvement, not only for the NHS in the UK but globally for health systems across the world.

    In many countries, including my country, Ethiopia, various investments have been made to improve the safety of healthcare delivery. We have been setting national minimum requirements/standards for health facilities, ethics and competence review systems for health professionals, but we have never had the confidence on the implementation of those standards fully. The implementation gap has become a long standing and consistent challenge in Ethiopia's healthcare system and many other systems.

    The Patient Safety Learning report highlights six specific policy areas where there is a gap that acts as a barrier to patient safety improvement:

    1. Public inquiries and reviews
    2. Healthcare Safety Investigation Branch reports
    3. Prevention of Future Deaths reports
    4. When patients and families take legal action
    5. Patient complaints
    6. Incident reports.

    Considering my 10 years of experience working in healthcare quality and safety, global health leaders and policy makers at national or international level should consider these areas during planning or executing any patient safety related policies. The COVID-19 pandemic has highlighted the huge challenges of building a learning health system and putting a clear leadership and governance structure for patient safety at national and health facility level. These conditions are clearly aligned with the four underlying thematic areas highlighted in the report:

    • Absence of a systemic and joined-up approach to safety.
    • Poor systems for sharing learning and acting on that learning.
    • Lack of system oversight, monitoring, and evaluation.
    • Unclear patient safety leadership.

    As a chair of the national Covid case management and facility readiness task force during the first and second wave of Covid pandemic in Ethiopia, one of the most important challenges I faced was lack of data and poor learning systems between Covid treatment centres to understand the patient safety situation in the treatment centres. One day I happened to visit one of the treatment centres with more than 20 ICU beds all occupied with patients. I tried to talk to the nurses and GPs taking care of the patients about their experience of medication error, machine failure or related incidents. None of the professionals had firsthand information and experience of documentation about those incidents. This experience of mine is a common experience and it is clearly aligned with unclear patient safety leadership and lack of system oversight for monitoring and evaluation.

    In most low and middle income countries, health workers are facing a lot of challenges due to resource constraints. These problems are amplified in Ethiopia. Working in stressful environments exacerbates safety risks for health workers, including being infected with COVID and contributing to outbreaks in the healthcare facility; having limited access or adherence to personal protective equipment and other infection prevention and control measures; and inducing errors that can potentially harm patients and health workers. For these reasons, addressing health workers safety can be a very good start to address patient safety.

    From my experience in the healthcare industry, I believe that creating a culture of safety in the healthcare setting is not easy. In the majority of cases, healthcare workers are positive about ensuring the safety of their patients and other healthcare workers. However, the healthcare workers' efforts must be supported by a policy and political commitment at national and global level to ensure everyone is safe in the healthcare setting. The recent Patient Safety Learning report, 'Mind the implementation gap: The persistence of avoidable harm in the NHS' outlines a very important policy perspective for experts and policy makers to consider.

    About the Author

    Yakob is a former Director General for Medical services in Ethiopia and the chair of national patient safety task force. He is a recent Humphrey fellow, Public Health Policy, at the Virginia Commonwealth University.

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    Greetings, Yakob.

    You have thoughtfully reflected and raised a couple of critical issues with which I completely agree. I believe that, in addition to designing evidence-based standards, the implementation of already available standards, protocols, and procedures should be prioritized.

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