Patient safety and health service quality

Poor quality and unsafe care remains common, especially in low- and middle-income countries. Disadvantaged groups are particularly affected. Health care itself often has unnecessary risks to health. One in ten hospital patients in low- and middle-income countries gets a health-care associated infection, of which many are preventable. Often, some real basics are missing: nearly 40% of health care facilities in low- and middle-income countries lack improved water and nearly 20% lack sanitation. Even where supplies are available, low adherence to hand hygiene and other safe care practices has been found. Poor quality, unsafe care is not just a hospital problem. A significant share of adverse events occurs in out-patient settings. Inadequate integration across levels of care and weak referral systems undermine care for complex conditions.

Poor quality and unsafe care extracts a heavy toll. The Lancet Global Health Commission on High-Quality Health Systems in the Sustainable Development Goals era estimates that more than 8 million people a year die from conditions that should be treatable by the health system. “Poor-quality care is now a bigger barrier to reducing mortality than insufficient access. 60% of deaths from conditions amenable to health care are due to poor-quality care, whereas the remaining deaths result from non-utilization of the health system”. Perceived poor quality can deter timely care-seeking or promote bypassing of facilities. The Lancet Commission found that wealthier households fare better than poorer ones in receiving care of adequate quality, with inequities being the widest in low-income countries compared to middle-income countries.

The associated costs are also high. For example, medication errors are estimated to costs US$42 billion each year. Poor quality care wastes scarce resources. Harm to patients results in broader economic and social costs, including from higher health costs, disability, lower productivity and earnings.

Progress towards universal health coverage (UHC) will be seriously constrained without improvement in the quality of both frontline services and inpatient care. Adequate quality and safety, especially in frontline services, can improve the public’s trust in health services and lead to increased use by those in need, reducing the pressure on secondary and tertiary care.

Most SEAR Member States have long had strategies to improve quality and safety, but challenges remain. Many quality improvement interventions are implemented by specific programmes. Many countries have national quality and/or patient safety strategies, with interventions targeted at different levels of health facility. To date, frontline services quality appears to have received less attention than hospital quality.

Improving health service quality and safety includes attention to the basics such as water, sanitation and waste disposal, as well as strengthened health worker capacity, the right policies and management at national and facility level, and increased engagement of patients and their families and communities.