atient safety is an umbrella term including a number of processes. It targets the absence of preventable harm to a patient during the process of healthcare and includes the reduction of risk of unnecessary harm to an acceptable minimum. It encompasses a framework of organised activities that creates cultures, procedures, behaviours, technologies and environments in healthcare designed to consistently and sustainably lower risk; reduce the occurrence of avoidable harm; make errors less likely; and mitigate the impact of harm when it occurs. Despite advances in treatments; technologies; and care models that have therapeutic potential, they introduce new threats to safe care, making patient safety a dynamic and crucial aspect of health care systems globally.

The World Health Organisation’s Global Patient Safety Report 2024 has provided the first comprehensive insight into the state of patient safety worldwide. It says while there has been progress in implementing policies, programmes and strategic interventions since the adoption of the Global Patient Safety Action Plan 2021-2030, advancements against several core indicators remain limited. This report underscores the importance of establishing systems to support safe practices, technologies and environments to prevent avoidable harm and reduce risk to patients.

Looking at various healthcare systems globally, we observe that the implementation process requires a systematic approach. The Joint Commission in the United States of America is a notable entity committed to improving healthcare safety by embedding patient safety standards into various domains, such as medication use, infection control, surgery, emergency management among others. These efforts are part of a broad strategy to create safer healthcare environments and cultures that reduce the risk and incidence of harm to patients. One of the cornerstone initiatives of The Joint Commission’s patient safety strategy is the National Patient Safety Goals. For 2024, these goals include specific measures such as the implementation of Suicide Prevention Resources to better support mental healthcare. Also, the information management standards, aimed at eliminating dangerous abbreviations, acronyms, symbols and dose designations to prevent medication errors. By collaborating with healthcare providers, The Joint Commission constantly analyses emerging patient safety issues and develops evidence based methods to address those. This iterative approach allows the organisation to integrate lessons learnt from the field into practical strategies, that enhance patient safety across various healthcare settings.

The Institute of Medicine in the USA has proposed the following six key aims for the healthcare system to ensure quality care: effectiveness, efficiency, safety, timelessness, equity and patient-centeredness. These aims are ensuring safety, which involves prevention of medical errors and adverse effects associated with healthcare; effectiveness, which addresses the avoidance of both underuse and misuse of healthcare services. A patient-centred approach emphasises the importance of involving patients in their care and tailoring services to meet their specific requirements. Reducing wait and sometimes-harmful delays for both those who receive and those who give care is essential. Also included are timeliness aims to improve the flow of patients through the healthcare system and minimise the time patients spend waiting for diagnoses, treatments and other services. Efficiency involves avoiding waste and maximising resources without compromising the quality of care and ensuring equitable care.

Patient education initiatives that inform patients about their rights and the importance of speaking up are essential to empower patients.

In the United Kingdom, the National Health Service Patient Safety Strategy, highlights the importance of building a safe culture and systems, empowering both patients and staff with the necessary skills and confidence to improve safety, which can significantly reduce the incidence of avoidable harm and associated costs. The NHS Patient Safety Strategy aims to continuously improve patient safety by building on the foundations of a safe culture and safe systems. It outlines how the NHS will support staff and providers in sharing safety insights and empower both patients and staff with the skills, confidence and mechanisms to enhance safety. Moreover, it is evolving a strategy to address the current challenges and priorities, focusing on areas of greatest need. It is structured around three strategic aims: insight, involvement and improvement, all underpinned by a patient safety culture and patient safety systems. The National Patient Safety Team supports the NHS in achieving these goals through various programmes and initiatives aligned with these foundational principles. On September 26, NHS-England published its Primary Care Patient Safety Strategy. This document highlights national and local commitments to enhancing patient safety in primary care, informed by research, including a significant 2020 study from the National Institute for Health and Care Research, Greater Manchester Patient Safety Research Collaboration, which aimed to improve patient safety. This research examined the incidence, nature and causes of avoidable significant harm in primary care in England, providing key insights and recommendations to mitigate risk and prevent patient safety incidents. Five main points from the strategy are: enhancing medication safety; integrating digital systems that alert health care providers to potential risks or adverse events; supporting staff to report and address safety concerns to approach risk management proactively; actively involving patients and the public in safety initiatives to ensure care reflects their needs and priorities; and focusing on reducing disparities in access and safety outcomes across different population groups, including implementing community-based care models.

Keeping in view these reports, how can we contribute to upgrading our healthcare systems locally? First and foremost, medication errors are preventable events that can lead to patient harm or inappropriate medicine use. They can be related to many things, including: prescribing, communication among healthcare personnel, product labeling, packaging, particularly in settings where medications are prescribed using brand names, dispensing, distribution, administration, education, monitoring and use. These errors often occur due to weak medication systems and human factors such as fatigue, poor environmental conditions, or staff shortages, leading to severe harm, disability and death. The global cost associated with these errors has been estimated at $42 billion annually. Multiple interventions are required to reduce the frequency and impact of medication errors. Secondly, effective protocols include comprehensive medication reconciliation, the use of electronic prescribing systems and regular staff training on safe medication practices. Finally, creating a culture of safety that encourages reporting and analysing errors without punitive measures is crucial for continuous improvement.

Ensuring that patients feel empowered to speak up about their concerns regarding safety and quality of care is crucial for enhancing patient safety outcomes. One effective strategy is to foster an environment where speaking up is encouraged and normalised. Healthcare professionals such as nurses and physicians can lead by example by regularly advocating for patient safety and encouraging colleagues to do the same. Creating a supportive environment where concerns are listened to, and acted upon, can help mitigate the hesitation often experienced by patients and healthcare workers. Healthcare institutions can implement digital technologies and training programs that focus on communication skills and the importance of voicing concerns for both new and experienced health care professionals. Additionally, patient education initiatives that inform patients about their rights and the importance of speaking up are essential to empower patients. Healthcare facilities can also utilise patient feedback mechanisms, such as surveys and suggestion boxes, to continuously gather and address patient’s concerns. Integrating evidence-based practices addresses challenges, supports innovation, and improves patient care quality for a better healthcare system, focused on harm prevention.

Dr Sobia Jawaid is a family physician at Evercare Hospital, Lahore.

Dr Hina Jawaid is an associate professor in family medicine at Health Services Academy, Islamabad