How to do no harm: empowering local leaders to make care safer in low-resource settings

Abstract

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a ‘portfolio’ approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

“…Actors from across the health system also need to prioritise interventions and be clear about the basic standard of care that is the initial focus. This may mean that specialists from across acute care disciplines need to develop the skills to understand and manage care for the critically ill patients, as a complex process spanning whole facilities 37 38. This includes lower level facilities, as care for the critically ill patients is not just the preserve of critical care specialists in their critical care units.…”

Receive, Sustain, and Flow: A simple heuristic for facilitating the identification and treatment of critically ill patients during their hospital journeys

“…Quality improvement approaches have been used extensively in African hospitals as they have in hospitals around the world [27,28]. Process mapping and improvements based on measurement and redesign remain powerful tools for reformers, but in settings such as those described here and possibly those in higher income settings, hospitals may lack the resources required to conduct detailed, granular analysis of root cause issues, careful measurement and redesign [29][30][31]. Similarly, while quality improvement approaches may be highly appropriate for well-defined areas of hospital areas, it would be a significant undertaking to try to use these methods to identify the root cause all problems affecting the care of critically ill patients across their hospital journeys whereas our heuristic offers a more simplified approach to uncovering problems affecting the care of critically ill patients and potentially other patient groups.…”