24 Oct 2012
Keynote address at the 29th International Conference of the International Society for Quality in Health Care, Geneva, Switzerland
Dr Margaret Chan, Director-General of the World Health Organization
22 October 2012
Distinguished delegates, colleagues in public health, ladies and gentlemen,
It is a great pleasure to address an audience committed to advancing safe, high-quality clinical care for all patients, rich and poor, now and in the future.
I thank ISQua, its officers, its programme and planning committee, and the support provided by the Canton of Geneva and the Geneva University Hospitals, for making this event possible.
The conference is timely for WHO. For many reasons, concern about the quality and safety of patient care is reaching new heights. Patient safety is on the agenda for next year’s Executive Board and World Health Assembly.
Patient safety is a complex multifaceted objective that demands a multi-pronged approach. The diversity of factors contributing to the safety and quality of care is well-reflected in the nine track programme for this conference.
Like WHO, you will be looking at top-down and bottom-up approaches. You will be looking at the role of provider education in reducing errors, and the importance of patients’ expectations, perceptions, and engagement.
Of course, hospitals are not hotels to be rated by their comfort or the quality of their food. But patient experiences yield important clues when things go wrong, and important insights into how to make things better.
You are moving beyond the hospital to consider other settings, including self-medication in homes. You are exploring innovative technologies and what they promise for the future.
Above all, you will be discussing ways to standardize and institutionalize protective and preventive measures, whether through policies, accreditation, and regulation, or practices in hospitals, doctors’ offices, pharmacies, and homes.
Patient safety is a comparatively new discipline that has rapidly risen to star status. This rise began in the late 1990s, with eye-opening reports documenting the scale of harm caused by medical errors.
These reports had media appeal, which gave them popular and political traction. And understandably so. Medical errors cause deep indignation. Health care should heal, not hurt, injure, or kill.
Documenting the costs has also helped quantify the magnitude of the problem. These are the costs of distress on the part of patients and providers, long-term if not life-time disabilities, and needlessly lost lives.
These are the economic costs of direct and indirect medical expenses, the recall of faulty equipment or contaminated medical products, and the settlement of clinical negligence claims.
I need only mention the current meningitis outbreak, in multiple states of the USA, linked to tainted steroid drugs, with as many as 14,000 patients thought to be at risk.
Let me illustrate the consequences of medical mishaps with just a few statistics. Worldwide, unsafe injections alone are thought to cause around 1.3 million deaths, with economic losses of around $535 million in direct medical costs. That figure represents an astronomical loss of around 26 million years of life.
The prospect of reducing such costs has further increased the appeal of patient safety, especially at a time of rising public expectations, soaring medical costs, and shrinking budgets.
Such conditions place a premium on strategies that tackle waste and inefficiency. When safety becomes part of the culture of clinical care, health systems see a reduction in unnecessary, costly, and often dangerous care.
As just one measure of this appeal, patient safety Global Challenges have been the fastest growing campaigns ever launched by WHO.
WHO is proud to be part of this movement. Together, we are turning clearly defined needs into concrete, practical, and highly effective tools that make the people, the patients, the winners.
Ladies and gentlemen, like any other young discipline, patient safety faces challenges. These include the need to change human behaviours, and the reluctance of medical professionals to acknowledge errors, on their own part or that of others.
To err is human, especially in today’s complex world of medical care with its increasingly sophisticated interventions and equipment. Errors can never be entirely eliminated, but their numbers and severity can be reduced.
Some medical mishaps are egregious and unforgiveable, like wrong-site surgery or releasing an infant to the wrong parents. These are the errors that make the headlines and blacken the image of health care. Fortunately, they are rare.
Other errors are less sensational, far more common, and greater in their cumulative impact, such as adverse drug reactions in the elderly and faulty prescribing practices that contribute to the emergence of drug-resistant pathogens.
What is disconcerting is that the same mistakes keep happening over and over again. This says much about the pressing need to make patient safety a top priority for any well-functioning health system.
This sentiment was well captured in a resolution adopted by the World Health Assembly in 2002. That resolution elevated patient safety to the level of a global priority for improving the quality of clinical care and strengthening the performance of health systems. That resolution recognized patient safety as a fundamental principle of all health systems.
As a young discipline, patient safety also needs a scientific framework rooted in multiple lines of evidence, a shared vocabulary, an accepted system of measuring and classifying adverse events, and a culture of transparent reporting.
I am pleased to note that efforts to address all these problems are being undertaken by national initiatives, international societies, like ISQua, and WHO.
But patient safety also has a number of advantages and unique opportunities, and these fuel the energy and excitement of events like this conference.
First, as I mentioned, patient safety has political appeal and popular traction, and this encourages accountability. I am thinking about the numerous chat rooms and blogs where patients share their experiences, good, bad, and sometimes horrific, holding individual facilities accountable for the quality of their services.
Second, solutions don’t need to break the bank. Measures for improving patient safety are often simple and comparatively inexpensive to introduce. For example, measures such as hand hygiene and safety checklists can be rapidly introduced. They also bring rapid results.
I can think of no other dimension of clinical care that responds so well to simple, common-sense interventions.
Approaches aimed at quality improvement leverage better results. They do so through changes in the way health care is delivered, not through a large influx of funds.
Third, solutions travel well. Many medical mishaps have common causes and common solutions that work well in rich and poor countries alike. The WHO Safe Childbirth Checklist is a good example of the kind of intervention that can make a night-and-day, life-and-death difference in clinical outcomes in the developing world.
What good does it do to offer free maternal care and have a high proportion of babies delivered in health facilities if the quality of care is substandard or even dangerous?
Fourth, patient safety resonates well with many of today’s burning issues in public health. All around the world, health is being shaped by the same powerful forces, like population ageing, rapid urbanization, and the globalization of unhealthy lifestyles.
Chronic noncommunicable diseases are on the rise everywhere, with the greatest burden now concentrated in the developing world. This means more and more people needing long-term if not life-long care. This means more and more people needing sophisticated hospital treatment for acute events.
The need for care is increasing in a world where health care is crippled by a shortage of 4 million doctors, nurses, and other health care staff, with the shortage greatest in areas most in need of care.
Taken together, these trends mean more opportunities for errors and unsafe practices to occur, everywhere. They mean increased pressure to find solutions that work well, everywhere.
Patients, in rich and poor countries alike, need and expect quality clinical care. Don’t disappoint them.
Finally, patient safety has passionate and articulate champions. I am pleased to share this podium with Sir Liam Donaldson. I am pleased that platforms established by WHO have given a voice to more than 250 patients groups and other champions in more than 50 countries.
As I said, I am proud that WHO is part of this movement.
Ladies and gentlemen, in clinical care, things will go wrong. To err is human. Some medical errors are unforgiveable. Others are more understandable. All can be addressed.
Health care will never be risk-free. But we can make these risks extremely rare rather than so disconcertingly common.
The best way to make progress is to learn from each other, with our eyes clearly on the patients as the ultimate winners. We want to heal, not harm.
I warmly welcome this conference, and wish you a most successful meeting.