Taking the pulse of quality of care and patient safety in the WHO European Region: Multidimensional analysis and future prospects (WHO, 11 December 2024)

Summary

This report presents the first cross-sectional analysis of quality of care and patient safety in the World Health Organization (WHO) European Region. It is based on an analysis of macro-level data from international sources and the results of a WHO survey conducted in 53 Member States. Critical gaps identified include limited implementation of national action plans and policies for quality of care and patient safety and wide variations in indicator outcomes for dimensions of quality of care, health system functions and population health outcomes across the region.

Content

Key findings in this report included:

• A scaling up of implemented national action plans for quality and patient safety, including a demonstration of learning and continuous improvement of better practices, processes and outcomes, is needed in the majority of countries. Only one third of countries implemented both a national quality of care and patient safety action plan.
• Hospital accreditation systems are implemented in only a minority of countries, hindered by a limited availability of evidence, particularly on their cost-effectiveness.
• Antimicrobial resistance (AMR) plans are widely available in countries, but ample opportunities remain to combat AMR. The majority of countries (79%) have implemented an AMR plan, but persistent disparities in AMR prevalence for Escherichia coli (E. coli) and methicillin-resistant Staphylococcus aureus (MRSA) remain across the region.
• Patient or public representation in national health governance is nearly non-existent, with only 13% of countries using this policy mechanism.
• Health misinformation prevention plans are absent in nearly all countries. Only four countries reported the use of a health misinformation plan. Such plans are important because they allow countries to deal effectively with infodemics during emergencies, including disease outbreaks, as well as with behaviours related to immunization adherence and noncommunicable diseases.
• The scarcity of the health and care workforce has significant consequences for the delivery of high-quality care.
• A limited number of countries have a national approved priority/essential medical devices list. Data show that only 22 countries have a national list of approved priority/essential devices.
• Electronic health records (EHR) are implemented in a low number of countries, jeopardizing the effective uptake of quality improvement interventions. Less than three quarters of countries (70%) reported having implemented EHRs, with only 13% having guidelines for quality and safety in telehealth.
• Patient safety-related indicators suggest a need for improvement with a high number of patient-reported medical mistakes.
• People-centredness indicators highlight important gaps in data collection on patient-reported outcome measures and experiences. Less than one third of the countries report on people-centredness indicators. Patient-reported outcome measures (PROMs) and experiences (PREMs) have important consequences for public confidence in the health system, health-care utilisation patterns, retention in care, and people’s decision to bypass facilities.
• Aggregated data mask inequalities within countries, showing a need for local systems of data collection and an evidence-base for equity-oriented policies.
• Poor population health outcomes highlight the need for a life-course approach and intersectoral action taking a quality of care perspective on the health of individuals and generations.

Policy actions

Based on the findings of the survey and towards addressing some of the challenges revealed across countries, a number of prospective actions to promote and/or ensure quality of care and patient safety emerge from the analysis.

1. Invest in whole-system quality that comprises integrated quality planning, quality control, and quality improvement activities.
2. Invest in the development of national action plans and policies for quality of care and patient safety.
3. Develop a harmonised set of indicators for measuring and continuously improving quality of care, including measures that matter most to patients.
4. Ensure patient and public representation in national health governance.
5. Establish clear, evidence-based standards for all care settings.
6. Re-design models of care around the needs and preferences of patients.
7. Invest in an health and care workforce with the capacity and capability to meet the demands and needs of the population for high-quality care.
8. Invest in robust public budgeting for quality of care and reconfigure payments to incentivise value in health service delivery.
9. Develop comprehensive and multistakeholder-led biotechnology sector policies to address quality and affordability for patients and health-care systems.
10. Invest in digital health solutions that support quality of care.