Patient safety and the human factor.
How safe is healthcare?

Healthcare is not as safe as it should be. Estimates show about 12% of patients still experience some form of harm associated with healthcare, around half of which is preventable. The World Health Organization defines patient harm as “an incident that results in harm to a patient such as impairment of structure or function of the body and/or any deleterious effect arising there from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury, and may be physical, social or psychological (eg, disease, injury, suffering, disability and death).”

What are the consequences?
Harmful patient incidents are also a major financial burden for healthcare systems across the globe. It is estimated that 10-15% of healthcare expenditure is consumed by the direct sequelae of healthcare-related patient harm.

Experts define preventable harm as the result of an identifiable modifiable cause and an event the recurrence of which can be avoided by the adaptation of a process or adherence to guidelines.

Root cause analyses show that most instances of patient harm result from a combination of individual failings, systemic weaknesses, and environmental factors.

What is considered inevitable harm today could in fact be preventable in five years. Definitions of preventable harm need to be continually updated.

Way forward
Firstly, it is important to capture all potential risks to patient safety, not just adverse events. Not all lapses in safety result in harm but instead are “near misses.” It is likely that the root causes of near misses and adverse events are similar
A second key strategy is to improve the ability to detect harm across all settings. Despite concerns around the prevalence of patient harm across health systems globally, the measurement of harm is often concentrated among a few high income countries and from limited care settings.
A third strategy is to increase patient and public engagement in identifying causes of preventable harm. Most studies included in the systematic review were retrospective assessments of medical charts, whereas few drew on information from patient reports. Yet the patient’s perspective is essential.

There is an urgent need for fostering a culture that allows for more systematic capturing of near misses, identifying harm across multiple care settings and countries, and empowering patients to help ensure a safe and effective health system.