“LESS HARM, BETTER CARE - FROM RESOLUTION TO IMPLEMENTATION”

Lara Serban | ETH Zürich

In the city where Freddie Mercury serenaded festival visitors with “Another one bites the dust” and only a boat ride away from the WHO Headqua ters, the Swiss Federal President Alain Berset hosted over 80 nations in Montreux for the 5th Global Ministerial Summit on Patient Safety. First held in London 2016, this summit was created as a means to bring together experts and policy makers with the goal to build comprehensive patient safety frameworks. These summits have raised awareness for patient safety worldwide – in May 2021, the 74th World Health Assembly endorsed the adoption of the first ever “Global Patient Safety Action Plan 2021-2030”, which outlines an international framework for patient safety.

The 5th Global Ministerial Summit on Patient Safety focused on “less harm, better care – from resolution to implementation”. As Alain Berset said in his welcome message:

“Awareness is largely in place and the relevant measures for improvement are well known. The problem is often a lack of adequate implementation.”

The dire need for efficient and sustainable implementation is currently gaining visibility in politics, mainly because the COVID-19 pandemic exposed many vulnerabilities in the healthcare system.

Why is patient safety important?

Patient safety is a public health issue in all health systems around the world. Insufficient patient safety implementation has long-lasting and deepreaching consequences. The implications affect all healthcare professionals and patients, from the level of individuals to societies as a whole. In addition to the ethical aspects, there are also financial perspectives to consider.

To “do care”, as we are urged to as healthcare professionals, means to cause no harm and especially to protect patients from avoidable harms. Improving and ensuring patient safety is a growing challenge to all health services globally, regardless of their respective socioeconomic status. Patient safety is an important part of evidence-based medicine and will therefore be a critical part of our future work as healthcare professionals.

Some challenges facing adequate implementation include:

• Lack of buy-in due to a paucity of understanding the matter and goal

• Unsuitable checklist design, failure to adapt to local practice and context

• Strong working hierarchies and clinician resistance to change

• Inadequate training of healthcare front workers and lacking feedback loops

Implementation science is defined as the scientific study of methods to promote the systematic integration of research findings and evidence-based practices into care delivery and the de-integration of low value care.

It actively engages multiple stakeholders while drawing from a rich theoretical foundation for understanding, designing, and evaluating complex implementation processes and their multilevel contextual interactions.

Our approach to implementation science is inherently interdisciplinary, systems-oriented, and cyclical in nature, and uses a multitude of research approaches. Positioned at the intersection of research and practice, the bidirectional aims of implementation science are to improve the quality and effectiveness of health care while also shaping future research priorities.

Here are some of the key messages from the expert panels that stood out to us: swimsa had the opportunity to send a delegation of three people to assist at the Patient Safety Summit 2023. This provided them the unique chance to gain insight into what goes on behind the scenes of such an event. We were a part of the division of International Affairs, Section EU & Neighboring States of the Federal Office for Public Health (FOPH), which organised the event at the Montreux Music and Convention Centre. Together with several FOPH interns, we prepared the goodie bags for the expert participants, assisted with guidance during the two days and helped with the session organisation. We had the chance to talk to several experts in patient safety, policy makers, and staff from the FOPH. These conversations helped us understand the complexities of global health efforts and the occasional difficulties in reconciling political and scientific priorities.

• The evidence and best practice plans for patient safety are available. The focus is shifting from resolution to implementation.

• Context is key! In every step of creating and implementing a patient safety plan, the context must be carefully analysed and taken into account accordingly.

• There is a clear tendency to remake, rather than reuse, pre-existing frameworks and guidelines for patient safety. An aptly-used metaphor to describe this phenomena was: “frameworks are like toothbrushes. Everyone has their own and nobody wants to use someone else’s”.

• Implementations must be measured and controlled in order to verify progress and sustainability.

• More complicated is not always better! Simpler plans usually require less resources to implement, but can still lead to significant improvement.

• Checklists have been proven to be a simple, yet highly effective tool. They should be an essential part of patient safety measures.

• Mistakes leading to adverse patient outcomes are usually due to systemic problems rather than individual mistakes. Patient safety plans and policies must take this into account.

• Effective implementation of patient safety plans has a good cost to benefit ratio! It is beneficial and profitable in the short, middle and long term.

• Best practice for implementation is a mix of bottom-up and top-down approaches: promote patient engagement, reinforce interprofessional collaboration and includemhealth care workers and other relevant stakeholders in the decision process.

Next Steps

Although progress has been made, further steps must still be taken to ensure optimal patient care. All nations have to develop and implement comprehensive, evidenced-based frameworks suitable to their healthcare system. Patient safety must remain a priority in policy making. The vision is clear and simple: eliminate all avoidable harm. The key messages from the summit will be summarised in the Montreux Charta on Patient Safety. All represented countries strongly support and expressed their will to implement the Montreux Charta. This Charta is meant to outline the global focus on patient safety for the next year and to hold the ratified countries accountable. Nevertheless, the Charta contains no concrete actions or mandates and has no direct legal consequences.

Given the time constraints of the summit, we realised that there was not enough time to properly discuss all aspects of patient safety. Even so, as young medical professionals, we would have hoped for more discussion about the following aspects:

• Planetary health (health care system resilience against climate change, antimicrobial resistance, social health determinants)

• Sustainability (In the sense of monitoring of the long-lasting effects as well as the intelligible use of resources in the respective contexts)

• Interdisciplinarity (communication and cooperation between different professions related to healthcare)

• Population/patient health literacy (being a cornerstone for self-responsible citizens

Alain Berset ended the summit with clear and memorable words. Drawing from his experience as a health minister during the COVID-19 pandemic, he urged politicians to be humble and ethical and not instrumentalize health crises for their own interests. He underlined the importance of strengthening collaboration with experts and upholding the free flow of important data and scientific knowledge within global communities to better facilitate responses to health threats.

Efficient and unrestricted collaboration within the international community is key for the resilience of healthcare systems. We look forward to the future of Patient Safety and, together with all relevant stakeholders, hope to contribute positively to this very important topic as we begin our careers in medicine.

Sources:

1. Implications of the COVID-19 pandemic for patient safety: a rapid review,

5 August 2022 | COVID-19: Clinical care

2. https://www.who.int/teams/integrated-health-services/patient-safety

3. https://pss2023.ch/

4. Aveling E, McCulloch P, Dixon-Woods MA qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countriesBMJ Open 2013;3:e003039. doi: 10.1136/bmjopen-2013-003039

5. https://www.ifis.uzh.ch/de/Implementation-Science/Ansatz-am-Institut-f%C3%BCr-Implementation-Science.html#:~:text=Implementation%20science%20is%20defined%20as,integration%20of%20low%20 value%20care