Global patient safety action plan 2021–2030:
towards eliminating avoidable harm in health care
Guiding principles
Compiled from: WHO Patient safety, pictures from the network
May 2021 2021 From January to June 1, ’s 74th World Health Assembly (World Health Assembly, WHA) was held in Geneva. The meeting passed the first "Global Patient Safety Action Plan 2021-2030" to eliminate avoidable health care harm. The action plan puts forward the vision, mission, goals, guiding principles, action partners, action framework and strategic goals. This article is one of the seven guiding principles.
We face a major challenge, that is, how to build a system to achieve universal health coverage, such a system will enable patients all over the world to enjoy safer medical care in the future. And this challenge is also the problem to be solved in this "Global Patient Safety Action Plan 2021-2030". The following seven guiding principles establish a set of basic values to guide the formulation and implementation of the action framework in this document. The framework includes 7 strategic goals and 35 specific strategic measures in the global action plan.
1. Treat patients and their families as partners in safe medical care
Safe medical care should be regarded as a basic human right, and medical and health services often require the participation of patients. Achieving safe medical care requires patients to know their condition, actively participate in various diagnosis and treatment activities, and receive treatment as a medical care partner in their own care.However, in many countries around the world, safe medical care is not as common as expected. Patients, their families and their caregivers have a keen interest in their own health and the health of their communities. They are users of the medical system. Whether they are fully involved and whether they are fully aware of the patient's condition is the key to ensuring patient safety. Therefore, patients and their families should participate in all levels of medical care such as policy formulation, medical planning, performance monitoring, informed consent, and joint decision-making. Patients, family members, and communities have made important contributions to ensure patient safety.
2 Achieve results through collaboration
WHO will take the " 2020-2030 Patient Safety Decade" initiative as a global mission to provide countries with policy guidance and implementation methods to make health care better Safety. At the local level, disruptive innovative measures and safer medical care models will inevitably emerge. They should be integrated into the global learning system, reshape the policy framework, and promote global discussions on patient safety. What we need is not one-way intervention, but a global cooperative ecosystem, where everyone from global policy makers to frontline health workers can make contributions and share learning with each other. All patient safety interventions in this framework need to be carefully designed and tailored to meet the priorities and specific implementation needs of different countries and communities. WHO will provide safer services through policy dialogue, strategic support, and technical assistance. Although the development and implementation of global patient safety actions may be helpful to reduce global patient harm, the key results of the plan will depend on whether the national, local, and local levels are committed to patient safety actions.
3 Learning from data analysis and sharing
Reporting systems that collect data on adverse events from medical points are being established all over the world. In 2020, WHO prepared "Patient Safety Incident Reporting and Learning System: Technical Reports and Guidelines." The report pointed out that such data also comes from medical incident claims, patient report experience, test result reports, clinical record verification, incident investigation, major incident verification, and safety monitoring data for blood products, drugs, vaccines and medical devices.Collecting data from these different sources provides a good opportunity to better understand the causes of security incidents and design preventive measures. However, in the current data collection work, inputting and storing data occupies most of the time and resources, and the time spent analyzing shared data is far from enough. Analyzing shared data can help people learn from it and continue to effectively improve patient safety. Data quality and reliability issues can be resolved by establishing a culture of trust in patient reports. Although the pattern and trend information related to injury types provided by these data is particularly eye-catching, our focus must be on its ability to improve the safety of future medical care.
4 Transforming evidence into implementable and measurable improvements
Many medical and health fields, including patient safety, have a weakness. The process of transforming effective evidence into routine practice is relatively slow. People sometimes call this the "know-do" gap. In addition, a wealth of patient experience and care knowledge helps to design and implement programs, thereby improving patient safety. In the process of formulating measures to improve patient safety, it is important to fully understand the change process and use the existing knowledge system to achieve the desired results. This also means that the leaders, managers, professionals and patients of medical institutions and clinical service departments need to develop close cooperation. The establishment of a training center for capacity improvement, encouraging people to learn, mastering and disseminating best practices is equally important for improving patient safety.
5 Formulate policies and actions based on the nature of medical care institutions
Most of the concerns and research on patient safety focus on resource-rich health care systems and the experience of large hospital groups. However, a lot of meaningful work has also been done in resource-poor environments. The first thing to be clear is that patient safety policies and solutions must be adapted to local conditions. They cannot simply be converted from one hospital to another, especially when there may be large differences in culture, tradition, medical and health system design, and infrastructure level. Secondly, experiential learning is not just one-way. Experience in finding patient safety solutions in resource-constrained institutions,It is also of great reference for the development of patient safety projects in the resource-rich medical and health system, and it is also of great value for the popular "south-north" route that advocates best practices.
6 Use scientific expertise and patient experience to improve safety
Nowadays, providing safety services to patients not only requires skills in planning, design, and strategic investment, but also involves patient support, increased patient awareness, policy commitments, and certain The lobbying ability and the support of localism. Traditionally, scientific and technical expertise comes from decision makers, health system leaders, health care professionals, academics, and managers, while strong emotions come from citizens, civil society organizations, and patient advocates. The formulation and implementation of the Global Patient Safety Action Plan requires not only scientific expertise, but also patients and their families who have suffered losses and serious injuries due to medical and health ills to express their approval and need their active emotional support. If the two factors of science and technology and personal experience can always be combined and work together, they will lead us to success.
7 The safety culture is nurtured in the process of designing and providing health care
The development of a safety culture is essential to improve patient safety. Policies and legislation can provide a favorable ecological environment for the vigorous development of safety culture. However, safety culture must eventually penetrate into the attitudes, beliefs, values, skills and behaviors of health workers and managers in medical and health institutions. Safety culture must be intertwined with the overall philosophy and overall culture of the organization. Although countries and organizations around the world can find the best way to nurture a safety culture, certain elements are still indispensable. Commitment at the leadership level, transparent, open and respectful communication, learning and lessons learned from mistakes and best practices, maintaining a delicate balance between the no-fault policy and accountability mechanism, these are all safety cultures An indispensable part. A strong safety culture is not only critical to reducing patient injuries, but also to ensuring a safe working environment for health workers. This requires creating a working environment that guarantees psychological safety.
【Original】
https://www.who.int/publications/i/item/9789240032705
Translation: Liu Jing, Chongqing Medical University 2019 Graduate Student of Nursing
Reviewer: Xiyue Chongqing Postgraduate of 2020, School of Foreign Languages, Medical University
Editor: Xiao Mingchao, Department of Urology, The First Affiliated Hospital of Chongqing Medical University
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