This blog describes the challenges faced in assuring patient safety in humanitarian settings and offers suggestions for how international medical aid organisations can build patient safety systems.
Unique factors affecting patient safety in humanitarian environments
As a nurse and quality of care advisor for Médecins sans Frontières / Doctors Without Borders (MSF), I know how challenging it can be to minimise healthcare-related risks in humanitarian settings. Medication supplies are disrupted when borders close or roadways are blocked by fighting. Patients delay care due to insecurity or unreliable transportation resulting in serious illness, and care complexity increases the occurrence of patient safety incidents. The health workforce shrinks with forced displacement that compounds health worker shortages already suffering from lack of investment in educational infrastructure. The built environment becomes less safe as investments for health facility infrastructure maintenance are diverted to crisis response. The voice of our patients is silenced as their care options diminish.
However, many elements of safe healthcare systems can transcend borders and care disruptions due to crisis. Institutionalising quality of care requires us as aid workers to challenge our ways of thinking and working.
Keeping patient safety at the forefront
Healthcare needs in humanitarian crises are overwhelming and prioritising services within overlapping, urgent needs is extremely challenging. An emergency response mentality – needed and appropriate during crisis – may also encourage us to favour access to care over quality. It can be tempting to deprioritise the mundane elements of patient safety in favour of urgent care provision and programme growth. We must navigate this tension and walk the line between emergency response and systems building that minimises risk as much as possible. This can be easier said than done.
Building and maintaining systems which support safe care delivery as part of humanitarian medical aid requires the following:
1. Humanitarian healthcare leaders who are engaged and committed to developing and maintaining a positive patient safety culture that is routed in patients’ needs are crucial. They must keep patient safety in the conversation, while at the same time working to respond to emergency situations or growing programming to meet evolving needs. It is essential that they express this commitment in organisational strategies and investment in the building blocks of safe systems, such as quality monitoring to measure clinically relevant and actionable indicators, collected not for reporting to leadership or donors but with the expectation to learn and improve. Staff development on patient safety and quality improvement is an additional requisite component, especially when healthcare workers do not benefit from this in their clinical curricula.
2. Systems to support learning from unsafe care across a range of environments are needed for ongoing learning and decreased risk to patients.
One common aspect of patient safety systems – incident reporting – must be tailored to the realities of humanitarian healthcare. Reporting systems need to be accessible to frontline workers without complex technology or internet connectivity. Incident data collected must capture not only clinical aspects of care delivery, but also the situational factors, such as supply chain disruption that can drive poorer outcomes during crises. More importantly, humanitarian workers must be empowered to speak up when safety issues compromise patient care, without fear of blame or judgment.
3. Aid organisations, including MSF, work in support of Ministries of Health and must be flexible. As more countries develop national strategies for quality of care and patient safety, aid organisations must be ready to support their implementation. In some environments, this may mean bolstering local systems, such as national incident reporting systems or monitoring tools. In others, it may be appropriate to replace an inadequately developed system or one that is unable to function due to the humanitarian context. The onus of doing both is on MSF and our peer organisations.
4. We must also adapt so-called 'best-practices' to different cultural environments. For example, patient advisory committees are often cited as an important part of patient safety assurance. In some settings, this may mean recruiting patients to participate on boards; this will necessarily look different in a place where traditional leaders speak for their communities or when relying on written communication may exclude community members from engagement.
Everyone deserves safe care
These suggestions probably sound familiar. Indeed, many are the basic components of patient safety programmes around the world. Keeping patients safe in humanitarian settings requires many common investments, but with adaptation to meet the unique challenges to safe care delivery.
Everyone, and especially the children and neonates who are the focus of this year’s World Patient Safety Day events and who comprise a significant portion of the people we serve, deserves to receive safe care. It’s up to us as aid workers to challenge our beliefs, our practices and our care processes and build a healthcare system that supports this right.
This blog describes the challenges faced in assuring patient safety in humanitarian settings and offers suggestions for how international medical aid organisations can build patient safety systems. Unique factors affecting patient safety in humanitarian environments As a nurse and quality of care advisor for Médecins sans Frontières / Doctors Without Borders (MSF), I know how challenging it can be to minimise healthcare-related risks in humanitarian settings. Medication supplies are disrupted when borders close or roadways are blocked by fighting. Patients delay care due to insecurity or unreliable transportation resulting in serious illness, and care complexity increases the occurrence of patient safety incidents. The health workforce shrinks with forced displacement that compounds health worker shortages already suffering from lack of investment in educational infrastructure. The built environment becomes less safe as investments for health facility infrastructure maintenance are diverted to crisis response. The voice of our patients is silenced as their care options diminish. However, many elements of safe healthcare systems can transcend borders and care disruptions due to crisis. Institutionalising quality of care requires us as aid workers to challenge our ways of thinking and working. Keeping patient safety at the forefront Healthcare needs in humanitarian crises are overwhelming and prioritising services within overlapping, urgent needs is extremely challenging. An emergency response mentality – needed and appropriate during crisis – may also encourage us to favour access to care over quality. It can be tempting to deprioritise the mundane elements of patient safety in favour of urgent care provision and programme growth. We must navigate this tension and walk the line between emergency response and systems building that minimises risk as much as possible. This can be easier said than done. Building and maintaining systems which support safe care delivery as part of humanitarian medical aid requires the following: 1. Humanitarian healthcare leaders who are engaged and committed to developing and maintaining a positive patient safety culture that is routed in patients’ needs are crucial. They must keep patient safety in the conversation, while at the same time working to respond to emergency situations or growing programming to meet evolving needs. It is essential that they express this commitment in organisational strategies and investment in the building blocks of safe systems, such as quality monitoring to measure clinically relevant and actionable indicators, collected not for reporting to leadership or donors but with the expectation to learn and improve. Staff development on patient safety and quality improvement is an additional requisite component, especially when healthcare workers do not benefit from this in their clinical curricula. 2. Systems to support learning from unsafe care across a range of environments are needed for ongoing learning and decreased risk to patients. One common aspect of patient safety systems – incident reporting – must be tailored to the realities of humanitarian healthcare. Reporting systems need to be accessible to frontline workers without complex technology or internet connectivity. Incident data collected must capture not only clinical aspects of care delivery, but also the situational factors, such as supply chain disruption that can drive poorer outcomes during crises. More importantly, humanitarian workers must be empowered to speak up when safety issues compromise patient care, without fear of blame or judgment. 3. Aid organisations, including MSF, work in support of Ministries of Health and must be flexible. As more countries develop national strategies for quality of care and patient safety, aid organisations must be ready to support their implementation. In some environments, this may mean bolstering local systems, such as national incident reporting systems or monitoring tools. In others, it may be appropriate to replace an inadequately developed system or one that is unable to function due to the humanitarian context. The onus of doing both is on MSF and our peer organisations. 4. We must also adapt so-called 'best-practices' to different cultural environments. For example, patient advisory committees are often cited as an important part of patient safety assurance. In some settings, this may mean recruiting patients to participate on boards; this will necessarily look different in a place where traditional leaders speak for their communities or when relying on written communication may exclude community members from engagement. Everyone deserves safe care These suggestions probably sound familiar. Indeed, many are the basic components of patient safety programmes around the world. Keeping patients safe in humanitarian settings requires many common investments, but with adaptation to meet the unique challenges to safe care delivery. Everyone, and especially the children and neonates who are the focus of this year’s World Patient Safety Day events and who comprise a significant portion of the people we serve, deserves to receive safe care. It’s up to us as aid workers to challenge our beliefs, our practices and our care processes and build a healthcare system that supports this right.
