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  • Patient Safety Spotlight interview with Ehi Iden, chief executive of Occupational Health and Safety Managers


    Patient-Safety-Learning
    • Nigeria
    • Interviews and reflections
    • New
    • Everyone

    Summary

    This is part of our new series of Patient Safety Spotlight interviews, where we talk to people about their role and what motivates them to make health and social care safer.

    Ehi talks to us about how building a connection with patients makes their care safer, the safety issues caused by lack of regulation, accountability and transparency, and the moral responsibility each of us has to speak up when we spot safety risks or see a patient harmed.

    About the Author

    Ehi Iden is an Occupational Safety, Health and Wellness Consultant with over 20 years’ work experience spanning through healthcare management, patient safety improvement and Occupational Health and Safety Management.

    He is the founding CEO of Occupational Health and Safety Managers (OHSM), a Head of Faculty at OSHversity and President, OSHAfrica. He is also the hub topic leader for Occupational Health and Safety: OSH Africa.

    Questions & Answers

    Hi Ehi! Please can you tell us who you are and what you do?

    My name is Ehi Iden, I am an occupational health and safety consultant in Nigeria, and I have worked in the healthcare space for over 22 years. I started my career in the healthcare sector before I went on to study occupational health, which I now apply to patient safety. I have masters degrees in workplace health and safety and business administration, and have undertaken training at many international institutions.

    I am the West Africa regional ambassador for the organisation Patient Safety Movement and coordinate work with patient safety advocates across different countries in the region. Each year I run a programme called Patient Safety Dialogue in Nigeria, where we bring stakeholders together and generate a conversation to try and influence patient safety policy in Nigeria.

    I first became interested in healthcare when I was 10 years old and my father was very unwell with a peptic ulcer. We lived in a rural area and the nearest quality healthcare was in a city quite a distance away. We eventually managed to get to St Camillus Hospital Uromi, a missionary hospital in Edo State in Nigeria, and I watched as several young doctors worked hard to stabilise my father. 

    I realised many years later that the passion I saw in those young doctors to keep my father alive was what inspired me to work in healthcare. He is now 96 years old and is alive because of the excellent care he received all those years ago.

    How did you first become interested in patient safety?

    When I started working in healthcare as a quality supervisor at 22, I realised that having a conversation with patients gave them hope, so I started doing ‘social rounds’ before the medical ward rounds. It meant I had an awareness of what was going on for each patient - I asked them how they were feeling, how the care had been and whether there were issues overnight.

    I built a connection with patients and they wanted to thank me when they left the hospital. I believe that’s because patients value care above treatment; matching genuine care with clinical practice is how we keep patients safe.

    When people come into healthcare, healthcare providers have a responsibility not to add to their pain and distress. I remember clearly the first case I saw of hospital-acquired infection - a patient came in with malaria and was discharged with chicken pox which she picked up when staying in a room that had not been properly disinfected. I also remember the case of a woman who was given medication she should not have been, and she reacted very badly to it. I realised it could be my mum, my dad, my siblings in that situation, so I took it as my responsibility to ensure safety whenever I can.

    Which part of your role do you find the most fulfilling?

    The part I find most fulfilling is when I have done my job, and a patient or healthcare worker thanks me. It gives me the energy to keep going. I really enjoy seeing someone who was brought in in distress leaving with a smile on their face, and knowing that I helped make their experience better.

    What patient safety challenges do you see at the moment?

    Nothing is more challenging than when you try to help a system, and the people working in it tell you they already know what to do. I know of health systems which have huge issues - I’ve spoken to the victims of these systems - and when I offer to help them improve their processes, they say, “No thanks, we’re already doing it.” So the problems remain and patients are still being harmed.

    In Nigeria, there is no body or system to hold healthcare providers and systems accountable. Patients are being harmed and even killed, but nobody has the responsibility to explain to family members what went wrong. Things will always go wrong in healthcare, but trying to sweep it under the carpet involves a deliberate intention to cover up the harm that has been suffered. There is also no clear way for patients and their families to raise concerns or make a complaint in Nigeria, and even when they manage it, the way it is handled is shrouded in secrecy. There are no clear policies or legislation from the government that state how the process should work. 

    The lack of regulation in Nigerian healthcare gives room for a culture with no accountability to thrive, which is very damaging to patient safety. And when things go wrong, family members are still expected to pay for the deficient care that caused the harm!

    Even when people have clear claims, it is so hard to get redress. A mother whose child was killed by a doctor’s clear malpractice ran a public campaign called Justice for Shawn to try and identify the doctor and prevent him causing more harm. It took years and years for the doctor to be suspended, and now he is likely to be back in practice. We don't know how many more Shawns were in the system that were never spoken about - so many incidents happen that never get reported.

    The government is supposed to be leading programmes on patient safety. But when we meet with government officials, they are not properly engaging, so it is private sector groups that are championing the cause. 

    What do you think the next few years hold for patient safety?

    From the global perspective, I am very happy to see that WHO has published a Global Patient Safety Action Plan 2021-2030. Now we need different countries to take the content and work it into domestic legislation and practice. It’s difficult to start building a system on your own, but if a global organisation offers help and guidance, it gives governments a starting point.

    I see a safer system in years to come, because people are getting more involved by the day. Events like World Patient Safety Day are important in raising awareness, but most of what is going on is driven by the passion of committed individuals. 

    I was driving home from work one day and heard someone on the radio describing some malpractice that happened to their daughter in hospital. I tweeted my email address and asked them to get in touch. All the way home I was receiving calls from people wanting to report harm - that’s how big this issue is. I got a lawyer I know involved, and we have created the architecture to allow people to take their claims to court if that is what's needed. We do it all on a pro bono basis.

    But for real change to happen in Nigeria and other countries, policy makers need to embrace patient safety, and they just aren’t doing it at the moment. We pursue this cause on a daily basis, but private sector leaders shouldn’t have to lobby for these laws - it’s the government’s job! These laws would benefit their families, as well as everyone else's. We have to make them see these laws will be a win-win for everyone.

    If you could change one thing in the healthcare system right now, what would it be?

    I would improve healthcare leadership. National leaders must commit to patient safety - once we get that right, we can build a safety culture. That’s where the discussion needs to begin.

    Are there things that you do outside of your role which have made you think differently about patient safety?

    I believe that advocating for patient safety is the moral thing to do. Healthcare is personal; just because I am not the patient now, doesn’t mean I won’t be tomorrow. 

    If I don’t speak up about problems I see in the system, I will get caught up in the things I refuse to address. “Evil prevails at the silence of a good man” - it’s time for the good men to start speaking up when things go wrong, in all systems and sectors. Silence is an endorsement.

    Tell us something about yourself that might surprise us!

    When I was a teenager, I wanted to be a reggae musician, but my dad told me, “Not while I’m still alive!” I played truant from school and then dropped out for a term. Eventually I decided to go back to school, because I saw my classmates and they didn’t want to associate with me. I knew I had to go back to school and catch up. 

    At university I took a national diploma in library and information studies and then a degree in mass communication. My father asks me, “What is the correlation between what you studied and what you do for a job now?” I always tell him, “I studied communication at university so that I would be able to communicate whatever I do in the future, well.” My diploma gives me the power to research, and my degree helps me to communicate my work.

    Related reading

    The 'Minutes of the Minute': a blog by Ehi Iden

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