The business case of unsafe The business case of unsafe care care - - PDF document

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Better knowledge for safer care

Itziar Larizgoitia Head Research & knowledge Management Patient Safety WHO

Research for Patient Safety

GCC Conference on Patient Safety 6-8 April 2009

Health care causes harm to patients

The business case of unsafe care

1 in 3700 1 in 65 1 in 16 Maternal mortality rates: North America: Asia (some countries): Africa (some countries):

Mothers and newborns

% deliveries in developing countries attended by health professional: 53%

• 16 billion injections a year in

developing countries

• 39.6% with syringes and needles

reused non sterilized (70% in some countries)

• Unsafe disposal can lead to re-sale
• f used equipment on the black

market.

The business case of unsafe care

The extent of harm caused by unsafe injections is unknown

• 5–15% of HIV infections in

developing countries are due to unsafe blood

• Unsafe blood risks transmission
• f: hepatitis B & C syphilis,

malaria, Chagas disease and West Nile fever

• Counterfeit drugs account for up

to 30% of medicines consumed in developing countries

The extent of harm caused by unsafe care is unknown

Deficit of qualified health-care providers

• The deficit in 57 countries is

estimated to be 2.4 million doctors, nurses and midwives

• Fatigue, production pressures

bear high risk of mistakes How to make best use of existing resources?

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The business case for unsafe care

• The problem of adverse events in health care is serious
• The problem of adverse events in health care is more

serious in developing countries. But only scant data are available

Knowledge for patient safety

1. Measuring harm 2. Understanding causes 3. Identifying solutions 4. Evaluating impact 5. Promoting change

• Launched in October 2004
• Chair Sir Liam Donaldson, CMO

England & Wales

• To catalyze international action to

promote safer care

• Collaborative Model

The WHO World Alliance for Patient Safety

Collaborative model

Systemic response to a systemic problem

• Leading to identification of locally effective

solutions

• Focusing on cost-effectiveness of risk-reducing

strategies

• Focusing on local priority areas:

– Counterfeit and substandard drugs – Lack of communication and coordination – Latent organizational failures – Inadequate competence, training and skills

Measuring Harm

• Estimating the global

burden of unsafe care

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Small research grants

• 500,000 USD/year to support 20-30 small

studies worldwide

• Targeting applied research to identify locally

effective solutions

• 21 Grants allocated in 2009

– Tunisia, Iran, Pakistan, – China, The Philippines, Vietnam – Myanmar, New Zealand, Thailand – Chile, Peru, Venezuela, Brazil, Mexico

• 21 teams starting to develop research

projects in collaboration with WHO

Research gaps

(less than 33% of respondents)

1. Health care associated infections 2. Health services research 3. Safe medicines and devices 4. Quality improvement 5. Qualitative research 6. Evidence based medicine 7. Ethical issues in research 8. Understanding causes 9. Blood and injection safety

• 10. Developing solutions
• 11. Patient involvement in research
• 12. Evaluating impact
• 13. Economic evaluations
• 14. Measuring harm
• 15. Human factors / safety design
• 16. Change management

< 30% < 20% < 15%

Global resource needs to promote research and research training (n=109)

42% 49% 46% 51% 48% 62% 84% 80% 94%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Protected time for teaching Protected time for research More teachers More researchers to mentor students More university courses and degrees "On the job" training to do research Training for teachers More research funding Funding of training programs

Funding Training Protected time Human resources

Research for Patient Safety is research for health systems with a focus on patient harm

Global Training Gaps

• Patient involvement in

research

• Economic evaluations
• Impact evaluations
• Developing solutions
• Human factors/safety

design

• Change management
• Measuring harm

Training Demands

• Quality improvement
• Safe medicines & devices
• Measuring harm
• Developing solutions
• Evaluating impact
• Understanding cause
• Health services research
• Human factors/ safety

design

• Patient involvement in

PSR

Mainstreaming health systems to avoid patient harm

• Focus research on the priority problems at

local level

• Focus research to identify cost-effective

solutions at the local level

• Advance the business case for patient

safety

Only in this way we'll understand the extent and nature of the problem

Catalyzing international commitment

• To mainstreaming patient safety in national

health systems

• To focus the importance of measurement to

understand the extent & nature of patient safety

• And to find locally cost-effective solutions to

locally priority problems

• To strengthening global and regional networking

for patient safety improvement through measurement

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www.who.int/patientsafety