South Africans sometimes imagine our country’s development to be far ahead of other African states but the truth is we have much to learn from our neighbours.
A national stakeholder symposium on health care rights and patient safety practice was held in Kampala in September 2018. The symposium identified 6 key themes for structuring the development of safety interventions in Uganda that may well be useful here.
- A national system for collecting, monitoring, sharing and learning from patient safety incidents.
The symposium considered evaluation of different models of national reporting and learning systems to be a priority. South Africa has made some progress in this area. Many private hospitals have patient safety incident reporting systems, and some provinces (e.g. Free State), supported by COHSASA, have had them in place too. A new voluntary patient safety incident (PSI) reporting system was implemented last year by the National Department of Health but no data have so far been published.
While reporting systems may be in place across the country and sectors, it is not clear whether we have learned how to convert incident reports and incident rates into improvement at the frontlines of care.
- Shifting from an individualised system of blame and liability towards a systemic approach, dispelling the persistent culture of blame.
In SA it’s still very much blame and shame. We have a long way to go to achieve a just culture.
- Including legal experts to provide insights into the regulation of safety in its reactive sense – through litigation – but also proactively through new legislation and regulation.
Legal experts should be included in the set of stakeholders engaged for patient safety. They can contribute a lot and also learn a lot, from a system perspective, about how errors occur and harm may be prevented. It is possible to develop models that better serve patients, families and providers than the current medical negligence “lottery”, which benefits few. For example – communication resolution programs.
- A broad, inclusive approach must be taken forward into the development of patient safety policies and initiatives.
These dialogues need a national platform, bridging private and public sectors. We await publication of the draft National Quality Improvement Plan which hopefully will help take us forward.
- National stakeholders should be involved in international patient safety collaborations.
Several agencies including the World Health Organisation are active in this area e.g. Partners in Health in Uganda and other African countries. Where existing collaborations exist at the governmental or policy level, these stakeholders should be actively included in pathways of communication.
- Community engagement has an essential role in disseminating patient safety information and practices and for empowerment of patients.
Uganda has apparently developed an effective model of community engagement to improve patient safety. The symposium recognised however that community organisations must be supported by other high-level stakeholders and that community-level action and engagement is not a replacement for an organised, effective central healthcare system.
The Uganda symposium was the first national platform for collaborative discussion about patient safety. These events could become a regular forum for the review and improvement of patient safety, guided by data and using quality improvement methodologies.