Dr. Nancy Varghese Thomas, a consultant on patient safety and healthcare quality improvement, who believes that patient safety in Kuwait has plenty of room for improvement, is convinced that any change, if it is to happen, has to come from the top down in a healthcare organization.
A dental surgeon and healthcare management professional with a dual Masters, in Public Administration and in Healthcare Management, from Boston. Dr. Nancy is member of several professional healthcare organizations. A Certified Professional in Healthcare Quality (CPHQ) from the National Association of Healthcare Quality (NAHQ) in the US. Dr. Nancy recently took time from her busy schedule to talk exclusively to The Times Kuwait about her experiences in healthcare industry and the quality of patient safety.
She began by explaining what patient safety and medical errors were: Though patient safety, as a critical element in healthcare delivery, started quite some time back, it was only from the late 1990s that it began to gain traction in hospitals and other medical institutions.
In the US, there is an American non-profit, non-governmental organization called the Institute of Medicine, which released a report called “To err is human: Building a safer health system” that showed over 98,000 people in US die each year from medical errors. It broke the silence that had surrounded medical errors.
This was shocking; as it was compared to being the equivalent of a jumbo jet full of people crashing each day of the year. This report was an eye-opener that made many in the medical community perplexed, because most of those deaths were preventable and many of those patients could have been saved with the right care at the right time.
In this part of the world, patient safety is not something that is generally given the priority. Here, the medical community largely believes that they are called on to only provide healthcare unlike safe preventive care.
In order to provide high-quality healthcare and ensure patient safety, there should be a desire on the part of management in medical institutions to set and achieve quality improvement goals. To do that, one needs to implement a scientific approach whereby all medical errors are properly documented and analyzed. These incidents would then serve as precedents on which further learning and training could be based on.
Medical errors can happen in so many ways; one must remember that most errors in medical care are not only from surgical procedures but they are the outcome of faulty prevailing system example, incorrect identification, wrong site surgery, incorrect prescriptions, or from medical staff who are not trained to what is needed when it is needed.
Most of the time, root cause is existing system rather than any individual. For instance, if the doctor was supposed to perform a right knee surgery for a patient and instead the surgery was done for the left knee. This is a ‘system’ error for which the blame will be put on the medical practitioner.
The healthcare industry is often compared to the airline industry, but it is not the same. On a stable day, the airline industry can rely on 99 percent of processes working as intended, but in the healthcare industry, even on a stable day you can rely only on 40-70 percent of the processes working seamlessly. While everyone would like to see a ‘zero medical error zone’ we cannot achieve this because we are dealing with human beings and to err is human.
Healthcare is an intricate combination of many different processes inter-linked together. When any medical error takes place we cannot categorically blame it as doctor’s or nurse’s mistake, it could in all probability be a mistake of the ‘system’.
But there are also a few cases where errors are caused by omission rather than commission. When omission happens, such as when omitting to do an operation or surgery itself, this is culpable and this is when suing issue come in.
How is patient safety here in Kuwait?
I don’t currently work here in hospitals, I do workshops and educational training to promote patient safety, but I believe that there is a lot of room for improvement when it comes to patient safety in Kuwait, especially in the following areas.
For beginners, data collection is an important component of healthcare in many advanced countries. This helps not only to provide a safe, effective, efficient and reliable healthcare for the patient but also for developing a proper healthcare database.
We need to shift the focus from individuals to the system as a whole. Once we begin shifting our focus on the system we can develop a more transparent and non-punitive healthcare culture which will help organizations to improve in leaps and bounds in the country.
Can you tell us of a memorable experience you were a part of?
It was during the time when I was an intern in one of the hospitals in Boston. I was posted in the NICU, (where the newborn are taken care). I was surprised to see how each provider was trained to perform their particular job in an emergency. Everyone did their part perfectly without waiting for anyone, and in a few seconds the baby was brought back to stable condition.
It was an eye opener experience for me and I truly believe that it is the system of any hospital that should change to deliver quality healthcare.
How does someone report an error if it takes place?
Occurrence reporting is one way of reporting an error in this region. Every hospital, be it private or ministry, is free to have their own policy and procedure. Incidence or occurrence reporting can be anything from the range of near misses to Sentinel events (suicide, death etc). Adverse event reporting (AER) is also a form of reporting where any medication error or anything that involves the life of the patient is reported.
Has technology helped in minimizing errors for patient safety?
Technology is indeed a blessing to healthcare industry in many ways. The relation between the patient safety and technology is through the role of electronic health records and other devices used for delivering healthcare. In healthcare, this would refer to the practical and applied methods that facilitate the delivery of care for patients, families, and providers.
An electronic health record (I) is a real-time, point-of-care, patient-centric information resource for clinicians. It includes patient information such as a problem list, orders, medication, vital signs, past medical history, notes, laboratory results and radiology reports, among other things. The (I) generates a complete record of a clinical patient encounter or episode of care and underpins care-related activities such as decision-making, quality management, and clinical reporting.
Technology in the acute and critical care settings are bedside monitors, computerized provider order entry (CPOE), Bar code medication administration system (BCMA), wristbands, mechanical ventilators, dialysis machines, point-of-care testing, infusion pumps, ventricular assist devices, and computerized information systems. Most of them are clinically oriented but a few are worth mentioning. CPOE helps medication and provider order safety by using software to make provider orders legible and the use of standardized treatment plan.
Wristbands must be used for all patients and in maternity wards for both the mother and the baby so that switching or abductions of babies can be prevented.
How do you think the situation here in Kuwait can be improved?
I think it is very important for top management in healthcare organization and other healthcare leaders to get involved. The expectation of people here is often topsy-turvy; they expect the bottom-liners to do well, without understanding that in order for that to happen, there should be proper training and mentoring from top level. A total evaluation of the healthcare system from the top to the bottom level is needed to rectify any existing drawbacks.
They need to rectify the process, not the person; unless they are trained alternatively, tomorrow ten more healthcare providers will repeat the same mistake made by a previous healthcare provider.
So, the change has to come from the leaders and to create a transparent and non-punitive culture, only then can there be patient safety.
By Madhuri Awale