As we join the rest of the regions of the world to mark World Patient Safety Day 2020 as adopted by the 72nd World Health Assembly Resolution - WHA 72.6 "Global Action on Patient Safety" in May 2019, it is important to strengthen the fact that both the safety of healthcare workers and that of the patients should be adequately protected. Owing to the COVID-19 impact on health and safety of healthcare workers as was evident globally, it became obvious the need to integrate these two issues into one for global conversation. The World Health Organisation has chosen a very apt theme for this year's event "Healthcare Workers Safety: A Priority for Patient Safety", this could not have come at a better time. This event was jointly organised in Nigeria by Occupational Health and Safety Managers (OHSM), Medical and Health Workers Union of Nigeria (MHWUN), OSHAfrica, International Trade Union Congress (ITUC), Patient Safety Movement Foundation (PSMF), Nigeria Labour Congress (NLC) and World Health Organisation (WHO).
According to the words of Florence
Nightingale over 160 years ago, “the very first requirement of a hospital is
that it should do the sick no harm”. As fresh as this statement still is today,
the question on the lips of everyone is, do we still play by this rule in
healthcare facilities? How comfortable are we when we send our loved ones to
healthcare facilities for treatment? Do we still feel sufficiently safe in
these facilities? These and many more questions are begging for answers.
As much as we advocate for the safety
of patients, we also need to remember that healthcare facilities are also workplaces
primarily before being a place where patients receive care. The need to also protect
the health and safety of the healthcare workers should be a very important
aspect in the conversations that surround patient safety. The honest truth is,
if we cannot guaranty the safety of healthcare workers, our hope of patient
safety and good treatment outcomes could be adversely jeopardized. This
multidisciplinary nature and complexity of healthcare systems is just a good
place to start. Good treatment outcomes and the safety of the patients is a
combination of many variables, it is difficult to give credit to specific sets
of professions within the system. Outcomes are always joint efforts of all
employees within the facility, this is one of the reasons why we advocate that
safety must start from the boardroom to the bedside, to the gate house and
beyond.
According to WHO, healthcare
facilities across the world employ over 59 million workers who are daily
exposed to a complex variety of health and safety hazards. Lately, the issue of
psychosocial hazards in healthcare sector has grown exponentially and this
burden has become a key indicator that could be attributed to the increasing
risk of patient’s harm. We are all aware how the work shift pattern in
hospitals have changed over the years, the increasing rate of workplace
violence against healthcare workers by patients and patients’ family members,
the increasing rate of the number of patients per healthcare worker in most
countries, the high rate of workplace stress and the increasing incidence rate
of accidental needle stick injuries among healthcare workers.
According to Dr. Teryl Nuckols, an
internist and Assistant Professor at David Geffen School of Medicine,
University of California Los Angeles “Residents are working more than 30 hours
at a single stretch and often times forgo sleep entirely”. In many healthcare
systems across the world, there seems prohibition on “mandatory” healthcare
worker overtime but nothing is seen on “voluntary” healthcare worker overtime.
Healthcare workers are at risk of violence across the world, between 8% and 38%
of healthcare workers suffer physical violence at some point in their careers.
According to 2014 report of Bureau for Labour Statistics, 52% of workplace
violence reported occurred in healthcare. Emergency Nurses Association Survey
of November, 2011 stated that 1 in 10 emergency room Nurses had suffered some
form of physical violence in a period of one week. This is the enormity of the
concern.
The poor infrastructural design in most
healthcare facilities has also posed certain levels of risks to healthcare
workers, a number of multiple floors facilities have neither elevator nor ramp.
Healthcare workers are made to lift patients or in some instances support
patients walking through the steps and this could lead to slips, trips and fall
leaving both the healthcare workers and patients with bodily harm. Advocacy for
safety at the design stage of healthcare facilities is a new conversation
coming out of this program. The Bureau for Labour Statistics in 2007 report
stated that slips, trips and fall are the second most common lost work-day
injuries in hospitals, it also added that incident rate for healthcare workers
are 90% greater than average for all private industries.
We appeal to all employers of labour
within the healthcare sector, the government and regulatory agencies to look
closely into the issues of healthcare workers safety and protection. The
healthcare work environment is highly infectious and what is needed most times
is only mitigation which comes in form of safe process designs, improved
hygiene practices, use of personal protective equipment and vaccination of
healthcare workers against infectious diseases with existing vaccines. In most
cases, the healthcare employers are never up to their responsibilities in this
regard, so obvious is the absence of duty of care from the employers. If you
recall the Ebola outbreak in West Africa 2014, over 378 healthcare workers were
infected while 196 healthcare workers death was recorded. When you again
juxtapose that with the report from the World Health Organisation (WHO) in July
2020, over 10,000 healthcare workers have been infected in Africa by COVID-19.
That report also mentioned that only 16% of the 30,000 facilities surveyed had
assessment scores up to 75%, this further explains how vulnerable the
healthcare workers are to infectious risks in their workplaces and the need to
fix this system towards improving the rate of patient safety and treatment
outcomes.
According to Dr. Moeti, WHO Regional
Director for Africa, there is an urgent need for us to rethink the entire
process, “the Doctors, Nurses, Cleaners and many other group of workers in
healthcare sector are our mothers, brothers, sisters and loved ones” and the
need to make them feel that sense of protection and care is our collective
responsibility. The world is already experiencing a high level of shortage in
healthcare workers and the increasing rate of harm, poor welfare and absence of
social safety net and protection will further increase healthcare workers shortage
and making the sector unattractive for new employments due to the prevalence of
risks with obvious lack of the culture of safety.
Our recommendations as we mark this
year’s World Patient Safety Day starts with the advocacy for the right kind of
leadership in healthcare systems globally and empathy being an integral part of
our health care systems. The need to stop the existing defensive culture and
replace it with a “just and transparent culture void of blame-game but owns up
to responsibility when things go wrong. Remember, we are only human and
everyone is fallible. “To Err is Human” according to the Institute of Medicine
(IOM).
We need patients to be at the center
of their care, if it is all about their health and wellbeing, they should be
involved in treatment decisions as it concerns their health. Advocacy for
patient-centred care is imminent.
The need to review existing health
systems legislations is important, we need policy makers to stand up for
change, healthcare technology companies to make the change by designing safe equipment
using safe new technologies. We need healthcare providers to be the change
through competency improvement and due consideration for patient safety so that
patients and their relatives can experience that change.
If we do not urgently commit to
actionable plans, the weight of the change of pain will greatly increase and
the number of people who are affected by that chain will greatly increase.
Remember, when we harm a healthcare worker or hurt a patient under our care, it
is not just that healthcare worker or the patient that we hurt, we also hurt
their family members.
In the words of a Nigerian songwriter, Timi Dakolo “There is a cry from a mother who just lost another child” The question is, who is next in line? This is a question we must all find an answer to.
Ehi Iden
References
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