Urgent need for global focus on patient safety, say experts

Patient safety is a key global health priority, and a new report sheds light on current challenges, opportunities and data gaps across the world.

Keeping patients safe from avoidable harm should be central to all health systems, and urgent action is needed, leading global health experts warn in a new report. The report, “Global State of Patient Safety 2023” provides valuable insight into the current state of patient safety around the world, through analysis of publicly available data from the last two decades. 

Produced by the Institute of Global Health Innovation at Imperial College London, and commissioned by the charity Patient Safety Watch, the report includes for the first time a user-friendly interactive data dashboard, case studies of patient safety excellence and a ranking of patient safety in OECD countries. 

Without global cooperation, the lack of data in global patient safety could lead to delayed or insufficient action, risking preventable harm and costing lives. The authors urge for data to better reflect the care journeys, perceptions, and experiences of patients. 

Gaps in data 

Timely, relevant and comparable data is crucial to monitor progress in patient safety, but the report reveals significant challenges in how data is collected around the world. The researchers set out 89 indicators for patient safety, covering areas from waiting times to treatable mortality, combining them into a dashboard to show which data were available or gaps, for each of the countries. 

Of the 89 indicators included in the dashboard, no country had all indicators populated. Australia, New Zealand and Norway have the highest availability of patient safety data available, with 75 populated indicators, while the UK has 68 populated indicators. The report also highlights the gaps in patient safety data in low- and middle-income countries (LMICs), with three out of every five indicators missing for LMICs. In addition, the research also highlights issues with the quality of data sources, with one in six indicators relying on data that is more than three years old, and only one in ten comes from data directly reported from patients. 

"To enhance patient safety, we must first recognise that progress is impossible without measurement. Our report underscores the urgent need to establish a robust global framework for collecting comprehensive patient safety data, addressing existing data gaps, and implementing meaningful indicators." Professor the Lord Ara Darzi

Professor the Lord Ara Darzi, Co-Director of the Institute of Global Health Innovation, said: “To enhance patient safety, we must first recognise that progress is impossible without measurement. Our report underscores the urgent need to establish a robust global framework for collecting comprehensive patient safety data, addressing existing data gaps, and implementing meaningful indicators. Collaboration is the key to progress, and it is imperative that we work together to elevate patient safety. Patient safety should be evaluated through the lens of the patient, and we must wholeheartedly embrace interventions that incorporate the perspectives of patients, families, and caregivers.” 

James Titcombe OBE, Patient Safety Watch, said: “I am optimistic for a future with improved patient safety globally. But there is much work still to do. In 2020, 800 women died every day from preventable causes related to pregnancy and childbirth worldwide. We must monitor and improve patient safety indicators and ensure that we engage patients in this effort.” 

Patient safety country ranking  

The novel patient safety ranking looks at the 38 OECD countries across four key patient safety indicators: maternal mortality, treatable mortality, adverse effects of medical treatment and neonatal disorders. Using this approach, Norway is at the top of the ranking, followed by Sweden and South Korea, while the UK ranks 21st out of 38 countries. There are significant opportunities for shared learning and improvement across comparable countries. Based on the latest data available, 17,356 lives could have been saved in the UK had it performed at the level of the top 10% of OECD countries. This would have meant 15,773 fewer deaths classified as treatable mortality, 776 fewer neonatal deaths, 27 fewer maternal deaths and 780 fewer deaths due to adverse effects of medical treatment per year.

Comparing healthcare systems based on publicly available data is challenging and complex. While rankings are a helpful way to assess how healthcare systems are performing and where they can improve, it's crucial to understand that the differences among countries are marginal, and therefore the relative position of a country within the ranking should be approached with caution. Due to data inconsistencies, creating a broader ranking across more indicators is not yet feasible. The report’s authors hope this ranking will inspire action and encourage better data collection, fostering a collaborative approach to improve patient safety on a global scale.

Patient Safety Data Dashboard

For the first time, the Patient Safety Data Dashboard presents a consolidated view of 89 publicly available global patient safety indicators. The report includes selected highlights, trends and opportunities for meaningful comparisons from the data. The authors find that many indicators have shown limited improvement over time, and there is significant spread in performance, even between comparable groups of countries. Globally, inequities in maternal care, waiting times, patient experience and medication safety are areas that stand out as requiring improvement. While the impact of the COVID-19 pandemic is not yet clear in the routinely collected data, a World Health Organization review indicates the pandemic has accentuated the risk of avoidable harm to patients. The pandemic placed health systems under immense stress, leading to re-directed attention and resources and significant backlogs in cancer care and other specialised treatments.

However, there have been positive overall improvements, such as lower treatable mortality rates, reduced inpatient suicides among mental health patients, and fewer maternal and neonatal deaths. Overall improvements have also been observed in the proportion of women receiving all four recommended antenatal care checks and the proportion of births attended by skilled healthcare staff. In addition, the report’s case studies showcase excellence in safety measurement and improvement which goes beyond the routinely collected data. These insights from leading patient safety experts, practitioners, and advocates provide optimism on how deficiencies in patient safety data can be addressed, although the challenge remains in how to foster the effective adoption of these approaches and interventions globally.

Key recommendations

The report authors urge healthcare professionals, policymakers, and stakeholders to explore the full report and data dashboard for in-depth insights into global patient safety. They also call for immediate actions that will lead to enhanced patient safety worldwide. Three key recommendations were put forward to enhance safety measures, reduce performance differences, and improve the measurement of patient safety on a global scale.

1. Assessment: A more balanced and comprehensive set of indicators is needed to address the data gaps identified through the report, and to ensure comparable data is available for countries across all income levels.
2. Adoption: A global repository of safety measurement and improvement interventions should be developed, and made freely available to frontline teams of practitioners and researchers
3. Activation: The adoption of patient-driven safety measurement and improvement interventions must be accelerated to support patients, families and carers to become active and equal partners in the delivery of safe care.

You can read the full report, and explore the data dashboard at www.imperial.ac.uk/stories/global-state-of-patient-safety

The Institute of Global Health Innovation delivers Imperial College London Health Policy courses. Study Health Policy at Imperial.