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Opinions of Wednesday, 18 September 2019

Columnist: Elom Hillary

Ten commandments of quality & patient safety

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On the maiden World Patient Safety Day celebration, I propose what I call 10 Commandments of Patient safety! This has been informed by experiences from practice and literature (Petrella, 1977). It is also informed by lessons learnt from other fields particularly organizational development. I believe that, if health systems globally heed to these commandments, there will be significant reduction in the needless harms that is inflicted on patients.

Patient safety is one of eight (8) healthcare dimensions (i.e. timeliness, integrity, efficient, effectiveness, integrated, equity, person centered care and safety) that define quality. It is a proactive process that involves the prevention and learning from harm!

Incidentally, it’s been twenty years since the publication of “to err is human” and a lot still needs to be done to improve the quality of care outcomes. These commandments are therefore suggested:

1. Thou shalt be authentic and genuine other than being fake, false and deceptive. Let’s make the patient happy. Let’s be nice to the patient. Let’s be “us” and portray our real selves and identities in the provision of care other than portraying our wishful selves! The beginning of authenticity is self-discovery!

2. Thou shalt show compassion and care other than cruelty, disregard, recklessness and lack of attention! Let’s prioritize the needs and expectations of the patient and the larger community other than our own selfish and parochial interest. Let’s facilitate the autonomy, independence and respect of the patient other than abandonment!

3. Thou shalt collaborate and work together other than competing and undermining one another. Let us codesign healthcare with the patients and consumers. Teamwork is key. No one person or professional can address the challenges of the health system. There is no heroism in the provision of quality and safe care!

4. Thou shalt be inclined to Emotional Intelligence (EQ) than Intelligent Quotient (IQ). There is too much emphasis on the mind than the heart and emotive aspect of care. The reason a pregnant woman in a village somewhere will bypass your nicely built and well-equipped maternity block to the traditional birth attendant in a dilapidated and ill-equipped “maternity home” somewhere inspite of all your degrees and qualifications is emotional intelligence competencies! We are happy for you about your degrees and qualifications, congratulations but it is not enough! Add EQ to your IQ to be whole! The good thing is that, EQ can be learned.

5. Thou shalt confront and speak up on issues and situations other than being laid back, dodgy and evasive. Let us empower people and ourselves to learn to name the elephant in the room!

6. Thou shalt be expressive of your feelings other than bottling up

7. Thou shalt integrate, coordinate. Let us make the provision of care access more seamless and a “one-stop-shop” across the patient journey other than fragmentation and segregation!

8. Thou shalt embrace continual learning other than blaming and shaming. A learning health system is stewarded by leadership committed to a culture of teamwork, collaboration and adaptability in support of continuous learning as a core aim.

9. Thou shalt embed human factors and ergonomics! Let us design health system to make it difficult for healthcare providers to make mistakes. Let us work to appreciate and understand the relationship between quality and systems! Let us stop passing the buck as healthcare providers always blaming the “system” for our inefficiencies and ineffectiveness forgetting that we are an integral part of the system! Fact is, without you, there is no system! Let us redesign our curriculum and medical education with equal emphasis on systems thinking and the use of medical jargons and vocabulary!

10. Thou shalt love. Thou shalt always remember what Donabedian said in your practice and provision care “Health care is a sacred mission … a moral enterprise and a scientific enterprise but not fundamentally a commercial one. We are not selling a product. We don’t have a consumer who understands everything and makes rational choices — and I include myself here. Doctors and nurses are stewards of something precious ...Ultimately the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system”

Finally, let us stop the lip service and propaganda to quality and patient safety! Let us demonstrate visible commitment which seems to be very much in short supply in many parts of the world. Let us uphold our individual and professional ethics and values in the provision of care! The question is, do you even have values and ethics as an individual at all?

Always remember that, it is your own individual ethics and values that is essential for the success of any system including healthcare! We are probably where we are because of our individual flaws and lack of individual values. The thing is, I can’t hear you because your character is louder than your voice!

OTCHI, Elom Hillary | FISQua, MPH, MA (Org. Devt), PGD, BSc
Expert, International Society of Quality in Healthcare (ISQua)
Technical Director, AfIHQSA