WHO launches patient safety guide

An Australian leader in medical education is helping to raise standards and drive down the error rate at hospitals around the world. By Linda Belardi.

The former head of the NSW Health Care Complaints Commission, Professor Merrilyn Walton, is the lead author of the first global patient safety curriculum for healthcare workers.

The education resource, targeting both students and experienced professionals, aims to drive down hospital error rates and to reduce unsafe care.

The World Health Organisation says the current state of patient safety worldwide is deeply concerning and error occurs in approximately 10 per cent of all hospital admissions.

The multi-professional guide builds upon the success of the curriculum first developed for medical schools in 2009 and now covers the disciplines of nursing, midwifery, dentistry and pharmacy.

Walton, who is professor of medical education at the University of Sydney, says the curriculum promotes a new approach to healthcare. It’s about putting patients at the centre of care and embedding a culture of patient safety, she says.

“Patient safety is not just another subject that you just teach. It’s a way of thinking. It’s about concepts and principles that you apply to everything you do at the patient’s bedside,” she told Nursing Review.

The curriculum aims to build the capacity of universities and hospitals to teach these core competencies. “A lot of the education and training around patient safety is just-in-time learning, where students learn the key concepts and then practise applying it. If this behaviour is repeated then it becomes routine.”

New topics covered in the curriculum include understanding the complexity of health systems, teamwork and medication safety.

Even though Australia is a world leader in developing patient safety curriculum, Walton says we are not leading the globe when it comes to implementing it.

“The challenge for undergraduate students once they enter the hospital system is to maintain safe practice even when the culture around them is not modelling best practice in areas such as hand hygiene, patient safety checklists and patient engagement.

“This is not an area where the young novices learn from the experienced staff. But what we need to do is to develop a system-wide approach to change, starting with undergraduates but also targeting clinicians and managers in hospitals in order to support staff to become knowledgeable about patient safety.”

Walton says the silos that currently operate between health professionals often act as a barrier to implementing a patient-centred approach. Currently only a fraction of the world’s health budget is spent on professional education for workers, she says.

“Unless health professionals appreciate why they are reporting events and the necessity to have a blame-free culture or a culture that learns from error and doesn’t punish, reporting alone won’t work. Education is the key to changing behaviour and having a safer healthcare system for patients.”

Changing the system’s relationship with patients is surprisingly one of the hardest aspects to teach and implement. “People have very entrenched views about patients. Quite often there is a paternalistic relationship rather than a partnership and many still don’t know how to communicate risk because it’s such a complex area in itself.”

The curriculum has been successfully piloted in every region including India, Africa and the Pacific and more than 200 international nurses, pharmacists, doctors and other allied health professionals attended the regional launch of the curriculum guide in the Philippines in October.

Walton is currently working with various WHO countries including China, Vietnam and Canada to help increase the skills of their experienced healthcare workforce in patient safety.

“Patient safety is about how you act and behave,” she says. “It’s not about high technology. Hand hygiene and infection control for example is a problem in every country in every hospital, it’s not just the developing or the developed.”

Walton also recently adapted the WHO patient safety curriculum for the NSW Department of Health specifically targeting novice health workers.

The Patient Safety Curriculum Guide, Multi-Professional Edition and supporting documents can be downloaded at: www.who.int/patientsafety/education/curriculum/Curriculum_Tools/en/

Key topics in the curriculum

Managing clinical risks in healthcare
Understanding complex health systems
Recognising adverse events and hazards
Teamwork and clear communication
Engaging the patient and carer
Sustaining a culture of patient safety
Improving medication safety