Patient safety culture: an unresolved challenge from the past

Guaranteeing maximum patient safety has always been a need. Since the times of Hippocrates, when the Hippocratic Oath —a text that includes doctors moral obligations towards their patients— came to be, this priority had a purely ethical nature and, as such, was not specifically considered a practical point subordinated to the quality of the care provided. Today, the concept of Patient Safety culture has changed. Now let’s see what this means.

What is Patient Safety Culture?

Patient Safety Culture, described briefly, has the purpose of avoiding injuries for patients during their assistance or while any clinical activity is developed. Ensuring reliability in patient care is essential to guarantee quality health services.

The consideration of Patient Safety Culture is relatively recent in many countries. However, in the United States, it started approximately two decades ago, according to the scientific publication Errar es humano. In it, it was concluded that between 44,000 and 98,000 people died each year in hospitals in the USA as a result of mistakes that occurred during the medical care process.

That report evidenced, through data, that health care implicitly carries an associated risk, which depends on three factors: patient vulnerability, the potential for human errors and system failures.

According to the World Health Organization:

The performance of positive health care must first ensure it’s provided in an adequate, balanced, complete and effective manner.

To ensure that the application of patient safety culture is beneficial, it is necessary to follow clear action policies and count with qualified health professionals who help improve safety for patients.

By recognizing patient safety as a global health priority, the WHO, at its annual Health Assembly, established the official World Patient Safety Day. Next, let’s go through the reason for this day and the importance of its meaning.

The origin of World Patient Safety Day

The first World Patient Safety Day is recent; it was celebrated on September 17, 2019 and, since then, it has been commemorated every year on the same date. This crucially important day was first established in May 2019, at the 72nd World Health Assembly, with the adoption of resolution WHA 72.6, entitled ‘Global action for patient safety.’

The main idea of the World Health Assembly is included in the motto and principle that best defines patient safety culture: ‘Above all, do no harm’

Let us now see a summary of the main principles of this action: 

What does the global action for patient safety establish?

• Patient safety will be guaranteed as long as the technology and medical devices used are safe.
• Health personnel must be highly qualified to be able to perform their duties while guaranteeing patient safety 
• Access to medicines and other safe and quality basic products must be managed correctly to contribute to patient treatment reliability.
• The importance of hygiene for patient safety culture and the prevention of healthcare-associated infections and for the reduction of antimicrobial resistance.
• Health services must be safe, regardless of where they are provided, for all people.

       (…)

The principles established in this Health Assembly determine importance of coming up with World Patient Safety Day.

The purpose of World Patient Safety Day is to promote patient safety. For this, it is first necessary to increase awareness and social involvement around it, and secondly, to work on an improvement in this regard at a global scale.

However, promoting patient safety is not enough, as damage continues taking place in healthcare-related processes. Every year, in low- and middle-income countries, 134 million people are harmed by the lack of hospital safety. As a result, 2.6 million deceases take place annually.

Similarly, primary and ambulatory care services see 4 out of 10 patients suffer injuries, and 80% of these cases can be prevented if there is adequate care.

What is the cause of patient harm?

The complexity of the environments where health care is provided leads to a greater propensity for human error. Expecting impeccable performances from people who carry out their work in stressful situations and environments is simply not realistic.

However, paying attention to the system in which potential damage might take place and examining it is essential for any improvements to take place. This enhancement will only take place in open and transparent environments where patient safety culture prevails above all else.

Main damage values because unsafe care

In the table below, you can see the damage rates and their extent: 

Damage burden / Rates of influence

Medication errors / One of the leading causes of preventable injuries and harm in healthcare systems

Healthcare-associated infections / These influence between 7 and 10 out of 100 hospitalized patients in high-income countries and low- and middle-income countries

Unsafe surgical procedures / Seven million surgical patients suffer significant complications, of whom one million die during or immediately after surgery

Unsafe injection practices / HIV and hepatitis B and C viruses: direct danger to patients and healthcare professionals. 9.2 million of life years due to disability and death worldwide

Diagnostic errors / These affect approximately 5% of adults receiving outpatient care. More than half of these errors can cause serious damage

Unsafe transfusion practices / Average incidence of 8.7 serious reactions per 100,000 units of blood components distributed

Irradiation errors / These include cases of overexposure to radiation and those in which the wrong patient or the wrong area is irradiated. General incidence of errors is approximately 15 per 10,000 treatment cycles.

Septicemia / Annually, 31 million people are affected by this worldwide, of which more than 5 million die

Venous thromboembolisms / They are one of the most frequent and preventable causes of damage to patients, and account for a third of the complications attributed to hospitalization. An estimated 3.9 million cases are reported annually in high-income countries and 6 million cases in low- and middle-income countries

Considering this data…

What are the main initiatives to improve patient safety?

Health care professionals around the world have campaigned for a Patient Safety Culture Law.

Many argue that a lack of patient safety culture is directly linked to an overload of patients compared to the number of nurses, a ratio which can be an indication of patient safety culture.

The ratio of patient per nurse should not exceed safety limits. If this happens, the risk to the health and life of people is significantly increased.

Nurse/patient ratio / Countries

1 nurse per 20-25 patients: Spain

5 nurses per 1000 inhabitants

1800-2000 citizens per nurse in health centers

230-250 residents per nurse in senior centers

12 nurses per 1,000 inhabitants: Germany and Ireland

14 nurses per 1000 inhabitants: Finland

17 nurses per 1,000 inhabitants: Norway and Switzerland

Nursing professionals’ campaigns seek awareness around the importance of safety culture. In fact, the data provided indicates the following:

• For each patient that is assigned to a nurse that is over seven, mortality increases by 4%.
• There’s an increased risk of death by 13% due to lack of health professionals, including nurses, TCAE (nursing care technicians), senior technicians and doctors in the centers.
• Too many patients assigned to the same nurse implies an increased risk of infection for patients. This triggers a greater probability of hospital readmission, especially in patients older than 65 years.
• Increase in healthcare costs and hospital stays can lead to hospital collapse.
• 15% of hospital spending in OECD countries (The Organization for Economic Cooperation and Development: international organization whose mission is to design better policies for a better life) is attributed to health care deficiencies.

In contrast to this not very encouraging data, the latest study published by the British medical journal The Lancet shows how greater healthcare support improves patient safety.

When the hospital’s ratio is 4 patients per nurse in the morning and afternoon shifts during a month, data shows a 7% reduction in the mortality rate. In the same way, the percentages related to readmission and hospital stays were reduced.

When it comes to human health care, it is reasonable to expect errors to occur. Doctors are not robots and their services include not only paying attention to their work and the relationship with one or several patients at the same time, but also to the operation of other elements, such as technology.

At this point, and taking into account results and research, it’s possible to conclude that patient safety culture depends on provided support.

That is why, if you want to contribute as a professional to improving this field, you can join our Master’s Degree in Sports Physiology, Physiotherapy and Psychology and take care of any potential new health problems in a rapidly growing sector.

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