Health worker safety deserves a second look

Mains: General Studies- II: Governance, Constitution, Polity, Social Justice and International relations.

Context:

The key is to adopt a systems approach and lay emphasis on a culture of health worker well-being

Harm in health-care settings:

  • Health facilities are a place of healing and restoration.
  • The world over, one in 10 patients’ experiences or is subject to harm in health-care settings like:
    • operations done on the wrong patient,
    • injections being administered in an unsafe manner.

Indian Scenario:

  • Studies in India have shown that more than two-thirds of injections are given in an unsafe manner
  • Over two-thirds of injections in primary care are unnecessary in the first place.
  • It is not uncommon to find health-care organisations observe strict hierarchies between specialties, between designations, and between doctors and other health professionals, such as nurses.
  • power differences can prevent reporting and cooperative organisational learning
  • It increases chances of abuse: verbal, physical, emotional and sexual, putting the safety of health workers and patients at risk.
  • India simply does not have enough health facilities to cater to all its population, even without a pandemic.
  • The lack of adequate social care, such as care homes, community health services and community-based rehabilitative and palliative services, unduly increase the burden on health-care facilities

Why is health worker safety important for patient safety?

  • To highlight this important issue, the World Health Organization observes World Patient Safety Dayevery year (September 17).
  • The theme for 2020 was ‘Health Worker Safety: A Priority for Patient Safety’ with a call to action to ‘Speak up for health worker safety’
  • Much harm done to patients in health-care settings is because of:
  • unsafe health-care practice
  • unsafe health-care communication.
  • Unsafe health-care practice refers to unsafe or unnecessary procedures, wrong medications, medications given in a wrong dosage, etc.
  • Unsafe health-care communication refers to mistakes made in health-care settings due to miscommunication between health professionals like during patient handover in between staff shifts.
  • The quality of both practice and communication is dependent on the safety and well-being of health workers.
  • numerous studies have shown that health workers, such as residents, who have been on duty for more than 24 hours at a stretch, have a higher risk of making mistakes, increasing the likelihood of a direct impact on patient safety.

Linked to the workplace culture:

  • During the current COVID-19 crisis, health workers are not only putting in longer hours but also working under increasingly difficult circumstances, which affect both their physical and mental health.
  • The mental health of health workers is linked to the workplace culture.
  • Some organisations have a culture of supporting staff,
  • Responding to the needs and encouraging learning from mistakes;
  • Others have a culture of fault-finding, blame, guilt and abuse.
  • When instances of patient harm occur, whether people feel encouraged to report them, depends on the organisation’s culture and leadership.
  • Without reporting, it is difficult for organisations to learn from mistakes and create systems, such as check lists in order to prevent similar future occurrences.

Organisational learning:

  • Organisational learning is more important than individual learning because:
  • Instances of patient harm, even when they occur at the individual level, are often an end result of a chain of organisational failures.
  • Systemic under staffing, lack of reporting mechanisms, lack of dedicated time for hand overs, audits, training and team building, poorly maintained equipment and corruption in purchases, are all organisational failures
  • Organisational failures gives cascade leading to avoidable harm to the patient.

Good systems can mitigate the effects of individual mistakes:

  • It is pertinent to look beyond the individual to look at the organisation as the sum of multiple elements that interact with each other. This involves taking a systems approach.
    • Example of overcrowding:
      • In many hospitals, quality of care is often compromised because of overcrowding, such as in the emergency department.
      • To take a systems approach in this situation would mean looking at it holistically — for example, from at least three angles using the input-throughput-output conceptual modeldescribed by Asplin et al in the Annals of Emergency Medicine in 2003.
  • Looking at whether patients who come to the emergency department need to be there in the first place or could be managed somewhere else such as in the community itself.
  • Looking at whether there are inefficiencies such as shortage of doctors, nurses, equipment or space that is increasing the time taken for patients to be treated.
  • Looking at whether the patients are staying longer in the emergency department than required because of lack of non-emergency department inpatient beds, delays at the pharmacy or delays in transportation of patients out of the emergency department.
  • The conversation on health during COVID-19 has often centred on individuals, with certain individuals, such as health-care workers, seen as heroes, and others (including those referred to as ‘super spreaders’ in a stigmatising way), seen as villains.
  • Many health workers have demonstrated excellence despite the limitations in the Indian health system.
  • Creating sustainability would involve taking a systems approach to make sure all parts of the system, both of health care and of supportive social care are well functioning.
  • Many health workers are overworked not by choice, but rather the lack of it since understaffing and shortages are a common feature of the Indian public health-care system..

Way ahead:

Stakeholder involvement

  • A systems approach involves all stakeholders.
  • Patients themselves need to be aware of patient safety as well as be empowered to demand safe health care and resist unnecessary medications and procedures.
  • Hospital managers must understand the need for and be empowered to create systems of reporting, monitoring and organisational learning.
  • Policy makers must prioritise staffing, co-designing functional and safe workplaces, and ethics in health care.
  • Numerous persons find healing and restoration in health care.
  • In crises such as COVID-19, quality of care can be compromised further. one can help improve patient safety by taking a systems approach and promoting a culture of health worker safety and well-being.