An intelligent person is never afraid or ashamed to find errors in his understanding of things. Bryant H. McGill

Doctors who work in hospitals have become inured to the frequency of errors, large and small, because they see them daily. However, many patients are terrified by the possibility of medical mistakes, which is why they dread hospitals. We are vulnerable when we fall ill, and we want to believe that the wise doctor and the gentle, caring nurse in the awe-inspiring hospital will help us to get better. We want to trust, and we expect excellence.

This is why when an error occurs, the patient’s confidence in health care takes a massive beating, and he feels betrayed and helpless. But even though the subject scares them, people want answers as to why medical errors keep happening, particularly since so many people have had first-hand experiences with them.

Technical aspects and human factors

* Safe health care delivery in a hospital has both technical and human dimensions.

Technical aspects include basic infrastructure, such as an uninterrupted electric supply; air-conditioning; potable water; and the safe disposal of medical waste. For example, if the electric power supply trips, and the hospital does not have a backup power generator, then all the patients on ventilators in the ICU will die.

The fire in AMRI Hospitals in Kolkata in 2011 which killed 89 people highlighted how vulnerable patients can be when they are in hospital. It is essential that the management invest in keeping the hospital environment safe for patients. There need to be fire safety drills, and extinguishers and fire safety equipment need to be installed, tested, inspected and maintained.

* Human aspects are equally important, because patient care has to be delivered by people – the doctors, nurses, paramedics and administrative staff.

The safety checklist for hospitals

Every hospital needs to have a full-time trained hospital patient safety officer, whose job is to help hospitals to reduce medical errors. The buck stops with her, and she is responsible for implementing measures, both to prevent errors, and to respond to them when they do occur. Safety should be the patient safety officer’s primary occupation, not an extra task in addition to other jobs. She should report directly to the CEO, and should have the authority to act and remove barriers to change.

The Safety Officer ensures that hospitals implement the following best practices. * Displaying the Patient Rights and Responsibilities Charter so a patient knows what to expect while receiving care at the hospital.

* Keeping two-way communication clear between the treating doctor and the patient or his relatives by ensuring that the doctor takes regular rounds. Since these ‘busy’ doctors are often too rushed to spend enough time at the bedside, there must be hospital-appointed patient advocates who act as go-betweens and inform the patient’s family about the progress the patient is making, at least twice a day.

* Making trained duty doctors and intensive care interventionists available round-the- clock and providing backup s t a f f o n weekends, when some senior doctors may take an unscheduled time off.

* Delivering bad news to the patients and their families about unintentional, adverse outcomes as soon as they are spotted.

* Clearly displaying CODE numbers - when to call whom - in case of medical emergencies (e.g.: CODE BLUE if a patient collapses).

* Creating “rapid response teams” for emergencies, when patients seem to be going downhill. The management of the crisis following an error can be improved with help from “extra hands” who bring an outside perspective and additional skills. * P r o v i d i n g clean and safe drinking water; sparkling clean restrooms and ensuring safe disposal of hospital waste to avoid contamination.

* Providing anti-skid flooring, well lit rooms and grip bars in the corridors and along staircases to prevent patient falls, especially in case of senior citizens. * Having an emergency power back up system that is tested regularly.

* Segregating, treating and disposing hazardous materials and waste , to comply with the Bio-Medical Waste (Management and Handling) Rules, to prevent the spread of infections. * Servicing medical equipment regularly, to prevent tragedies like the horrific incident in 2009, when five newborns in an incubator were fried to death in a Punjab hospital after a short-circuit sparked a fire in the nursery.

The National Accreditation Board for Hospitals and Healthcare Providers (NABH), under the Quality Council of India (QCI) and the Ministry of Health & Family Welfare has set safety standards for the health industry that hospitals need to comply with. However, medical errors are still rampant in hospitals because the management is not convinced that investing in safety is cost effective.

The tragedy is that hospitals would rather spend on fancy new MRI scanners and state of the art Operation Theaters, rather than try to implement such low-tech, unglamorous concepts as safety. This will change only when the hospital management starts to feel that they will be rewarded in the marketplace by investing in safety. Until then, even though they will continue to pay lip service to safety, this will always remain an after-thought in the budget.