Medical Matters: Steps made towards patient safety are just the beginning

Patient safety is rightly a huge issue for our health service. Unfortunately, most of the focus has been reactionary, in the form of inquiries revealing how the deaths of the babies at the Midlands Regional Hospital in Portlaoise, or of Savita Halappanavar in Galway, could have been avoided.

It was good, therefore, to see the Medical Council use the publication of its five-year strategy last week to tackle patient safety proactively.

In a dysfunctional health system, an important champion of patient safety is the Health Information and Quality Authority (Hiqa).

A key element in its success in its first seven and a half years has been the leadership of its chief executive, Dr Tracey Cooper, who has just announced she is stepping down from the post.

Among her many successes are the inquiries into the treatment of the breast-cancer patient, Rebecca O’Malley, and the delayed reporting of X-rays at Tallaght hospital, both of which led to significant changes for the better.

Team success
While it is probably unfair to pick out a single initiative to highlight the success of Cooper and her team at the authority, the publication in 2012 of the National Standards for Safer, Better Healthcare is surely a highlight.

The health service in the Republic was essentially flying blind, pending implementation of these standards.

Individual health professionals had attempted to do their best for patients in a porous health service where systems were either non-
existent or liable to crumble at the slightest sign of pressure.

Now we have 45 standards with legislative teeth; in Cooper’s words, “the standards provide, for the first time, a national and consistent approach to improving safety, quality and reliability in our health service”.

Standard 2.4 states: “An identified healthcare professional has overall responsibility and accountability for a service user’s care during an episode of care.”

In practice, this means you can expect to receive safe and co-ordinated care when being looked after by more than one healthcare professional; when you move between different services, such as when your GP refers you to a hospital for further care; or when you move within or between hospitals and services.

So with Standard 2.4 in place, there is no doubt about who is responsible for a patient who has been admitted to hospital but who is waiting in the emergency department for a free bed.

A failure to follow up blood test and X-ray results has featured in a number of inquiries into poor patient care.

'Necessary skills'
Standard 2.6 comes into play here, namely: "The people providing your healthcare have the necessary skills and experience to provide safe care for you as they regularly care for people with the same or similar condition; the service only delivers those services that it knows it can deliver safely and effectively; and if the service where you are currently receiving care is unable to meet your healthcare needs, you will be supported to access a different service that can provide the necessary care."

What about occasions when something goes wrong? Healthcare providers are now expected to “model” such scenarios so they respond quickly to possible risks. After an adverse outcome, there is a commitment to look at what happened and how it happened, with the aim of trying to prevent it happening again. Which feeds into the principle of “open disclosure”, now an internationally accepted norm.

Adverse outcome
Referenced in the Medical Council's strategy document, doctors here were reminded of their obligation to inform patients when an adverse outcome occurs.

We now need to move to a system of licensing individual hospitals so that they are regularly assessed to see if they are meeting standards. And managers in the HSE must be held accountable when they breach national standards.

Cooper is moving back to her native Wales to take up a senior post there. It is sobering to think how much worse our health system might be without her steady leadership.

mhouston@irishtimes.com
muirishouston.com