Advancing patient safety: Progress and challenges in India’s healthcare landscape

Dr Kishore Kumar, Founder Chairman & Executive Director, Pediatrician & Neonatologist, Cloudnine Group of Hospitals, Bengaluru highlights that while patient safety challenges exist in India, efforts are underway to address them and enhance the overall quality of healthcare, ultimately ensuring the well-being and safety of patients across the country is the key

We all know, Patient safety is a critical concern in India’s healthcare system and from challenges including inadequate healthcare infrastructure, a shortage of healthcare professionals, and disparities in healthcare access and quality it needs many reforms. Each year, 134 million adverse events occur in hospitals in low- and middle-income countries (LMICs), due to unsafe care, resulting in estimated 2.6 million deaths. Misdiagnosis, falls, infections and mistakes during treatment are the most common types of PSIs. Those who have experienced a PSI most commonly cite distracted or overlooked HCPs as the biggest contributing factors that led to the incident.

Challenges

Infection control is one of the biggest areas that needs attention. Infections acquired in healthcare settings, such as hospitals, remain a significant concern. Efforts to improve infection control practices are crucial to ensuring patient safety. Medication errors is next one big area that is a common issue in a country like India and often factors like inadequate training, poor communication, and lack of standardised processes makes our country well known for this.

Maternal and Neonatal care is one of the crucial areas which needs immediate and all-time attention. Ensuring safe maternal and neonatal care is a priority, with initiatives to reduce maternal mortality and improve neonatal outcomes. We as a country collectively lack promoting patient education and empowerment. Increased awareness amongst patients is gaining traction to help patients actively participate in their care and recognise safety concerns but issues like violence against doctors continues to remain at its peak.

The Indian government and healthcare bodies have introduced regulations and accreditation programs to enhance patient safety. For example, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) sets standards for quality and safety. The adoption of technology, including Electronic Health Records (EHRs) and telemedicine, is helping improve patient safety by reducing errors and improving communication among healthcare providers but again there is a lot more to be done. We are missing on many initiatives for healthcare professionals, such as training programs and workshops on patient safety, are essential to improving practices.

What should we do?

While patient safety challenges exist in India, efforts are underway to address them and enhance the overall quality of healthcare, ultimately ensuring the well-being and safety of patients across the country is the key. We need to improve patient safety at a national level which requires a comprehensive approach involving various stakeholders, including government bodies, healthcare institutions, professionals, and the public. Here are several actions that can be taken in my view to enhance patient safety:

Develop and enforce regulations: Establish robust healthcare regulations and standards that prioritize patient safety. Enforce these regulations effectively to hold healthcare facilities accountable for safety lapses, both private & public.

Accreditation programs: Implement accreditation programs for healthcare facilities, such as hospitals and clinics, to ensure they meet specific safety and quality standards, including outcomes of the treatment/s. Encourage facilities to pursue accreditation.

Training and education: Invest in ongoing training and education for healthcare professionals, focusing on patient safety practices, communication, and error prevention.

Technology integration: Promote the use of healthcare technologies like Electronic Health Records (EHRs) and Computerised Physician Order Entry (CPOE) systems to reduce medication errors and improve data accuracy.

Patient engagement: Empower patients to be active participants in their care. Encourage them to ask questions, understand their treatments, and report safety concerns. Implement systems for gathering patient feedback, especially public healthcare.

Medication safety: Develop systems to prevent medication errors, including barcoding, medication reconciliation, and pharmacist involvement in prescribing and dispensing.

Infection control: Implement rigorous infection control practices in healthcare facilities. Regularly monitor and report on healthcare-associated infections.

Adverse event reporting: Create mechanisms for healthcare providers to report adverse events could be anonymous reporting to start with and near-miss incidents without fear of reprisal. Analyze these reports to identify trends and areas for improvement.

Research and data collection: Support research on patient safety to identify emerging risks and best practices. Maintain a national database for adverse events and patient safety incidents.

Public awareness campaigns: Launch public awareness campaigns to educate the public about patient safety, their rights, and how to be active partners in their healthcare.

All this is possible only when we aim at fostering collaboration among healthcare institutions, professional associations, government agencies, and patient advocacy groups to create a unified approach to patient safety. This will help in promoting transparency in healthcare and allow pushing more data in the public domain to make more informed decisions.  Sufficient allocation of financial resources will support patient safety initiatives, including staff training, technology upgrades, and quality improvement programs.

This is probably the best example of patient safety “when the USA sneezes the world catches cold”. World Patient Safety Day is one of WHO’s global public health days. It wasn’t established until 2019 when the 72^nd World Health Assembly adopted it through the resolution WHA72.6 – “Global action on patient safety”. But as a growing healthcare institution servicing the mother and childcare industry from last 16 years, at Cloudnine we have been very conscious of the patient safety from inception – and have been insisting on incident report being raised – whenever there is an error – these incident reports being reviewed by a panel – comprising of a panel of experts and then it is judged if it is critical, non-critical – and suitable action is taken – in educating the relevant people to avoid future problems. All critical errors, if any, are informed to the patient and the family in a congenial atmosphere. In that sense, we have been very conscious of patient safety from day 1 – and we have no doubt one of the lowest morbidity and mortality rates in India.

Next milestone

Improving patient safety is an ongoing process that requires dedication, collaboration, and a commitment to learning from mistakes. It’s essential for the health and well-being of the population and for maintaining trust in the healthcare system. We must develop standardised protocols and best practices for patient care to reduce variations in treatment and improve safety. We must implement comprehensive medication safety reforms, including barcoding, electronic prescribing, and automated dispensing systems to minimise medication errors. Besides this our incident reporting systems need to be more robust that encourage healthcare providers to report adverse events, near misses, and unsafe conditions without fear of retribution. Data is the key and analysing reported incidents to identify trends, root causes, and areas for improvement will help us in coming up with safety measures.  We need to invest in patient involvement in their care, including shared decision-making, clear communication, and education on how to recognise and report safety concerns and this can be achieved only when we invest in ongoing training and education for healthcare professionals, emphasising safety practices, teamwork, and communication skills. Remember, collaboration among different healthcare disciplines to improve communication and teamwork, reducing errors and improving patient outcomes is the key to achieve this success in the long run.

Last but not the least, continuous monitoring to evaluate the effectiveness of patient safety reforms and make necessary adjustments will help in raising awareness, promoting reforms, and holding healthcare organisations accountable. Patient safety reforms are an ongoing process that requires collaboration, commitment, and a willingness to adapt and improve based on the evolving healthcare landscape and emerging challenges. Violence can disrupt patient care and potentially harm patients if healthcare professionals are unable to perform their duties due to safety concerns. Our healthcare system needs to implement measures, such as access control, surveillance, and the presence of security personnel, to deter violence. Healthcare institutions should adopt zero-tolerance policies for violence against healthcare professionals and communicate these policies clearly to patients and visitors.

India faced challenges related to healthcare infrastructure, resource allocation, and healthcare worker shortages, which could impact patient safety. From infection control in healthcare facilities to medication errors, misdiagnoses, and lack of standardised protocols, in the 21^st century, patient awareness and involvement in their care is the need of the hour. It is crucial to strike a balance between protecting healthcare professionals from violence and maintaining an open and accessible healthcare system.