Abstract
On April 13 and 14, I found myself in the Tokyo hotel where the acclaimed film ‘Lost in Translation’ was filmed (Coppola 1 ), together with a throng of international patient safety experts, key international organizations and high level government delegations from ministries of health in 42 countries. The occasion was the Third Global Ministerial Summit on Patient Safety, organized by the Japanese Ministry of Health, Labour and Welfare, with technical support from Germany, the United Kingdom and World Health Organization. The Summit was the third in a series initiated in 2016 by ministers Jeremy Hunt from the UK and Hermann Gröhe from Germany and following the 2017 meeting in Bonn.
Although the focus of the meeting was on patient safety, there were a few undercurrents: the ageing of societies, the pull towards universal health coverage, the shift from hospital care to population health, the rise of information and communication technology and persistent concerns about costs. Spring came early to Tokyo this year, so the participants were two weeks late for the peak of the cherry blossoms. However, they were treated to some stimulating sessions and came away with important insights. I took away five inter-related messages:
Patient safety is a critical component of universal health coverage. Dr. Victor Zhao, president of the US National Academy of Medicine, asserted that ‘Nations will fail to harvest the benefits of universal health coverage if they do not also work on quality efforts – these should not be an after-thought’. Patient engagement is critical to improving safety and quality. It is the future of healthcare, as sharing with patients and families is also essential to a successful pivot from hospital focused care to population health. More and more information about healthcare is available every day. When it is used wisely, it can make both providers and patients smarter. Dr. Shunzo Koizumi, emeritus professor at Saga University, summarized ‘We should give patients more power at all levels, starting now’. Provider engagement is critical to improving safety and quality. Dr. Don Berwick asserted that ‘health care institutions must choose between fear or safety – Fear poisons safety, which can only thrive in a culture of trust, learning and openness’. Only when providers feel it is safe to talk about their own experience with safety problems can we learn from practice. Effective patient safety interventions should be designed for community care, accounting for growing numbers of older adults worldwide. Interventions and resources should be progressively shifted to primary and long-term care, with active involvement of citizens, families and communities. Upfront investment in patient safety provides an excellent return-on-investment as evidenced by a range of studies from around the world. Leadership and coordination are crucial both within and across nations to support patient safety research and produce information that allows us to account for gains made in health and safety.
Despite the diversity of languages, cultures, political systems and economic development, delegates agreed that progress to ensure patient safety is too slow and too fragmented. All agreed on the need for a global action plan for patient safety. Accordingly, the Tokyo Declaration on Patient Safety, 2 put forward by Japan, Germany, the United Kingdom of Great Britain and Northern Ireland, was endorsed by an additional 21 countries and 6 major organizations. In part it states (full declaration available at http://www.mhlw.go.jp/file/06-Seisakujouhou-10800000-Iseikyoku/0000204005.pdf)
We declare that we will: Affirm our strong commitment to maintain a high level of political momentum on “Global action on Patient Safety” in countries around the world, and to work closely with countries across the world, including low- and middle income countries, in order to strengthen capability through collaboration and learning; and to prioritize patient safety in health sector policies and programmes while advancing efforts towards Universal Health Coverage (UHC) Pledge to support and enable health care institutions, both public and private, from the level of primary care through to referral level care, to implement changes in systems and practices to improve patient safety, while contributing to UHC and Sustainable Development Goals; Commit to building capacity in leadership and management to support patient centered care, implement and strengthen patient safety systems and processes, create a culture of safety and transparency, align incentives, educate and train the health workforce in patient safety, engage patients and families, increase efficiency and minimize harm by sharing knowledge on risks, best practices and successful models; Work collaboratively with patients and families who have been affected by harm, international organizations and other key stakeholders to increase visibility and work towards global action on patient safety, including the establishment of an annual World Patient Safety Day to be celebrated on 17 September each year.
Papers in this issue echo some of the key themes from the Tokyo summit. Gurses et al. 3 describe the importance of design, presenting an example of how human factors principles and methods helped make a critical piece of personal protective equipment – the Ebola suit – more effective in preventing transmission.
Guzman 4 describes progress that has been made in Rwanda to implement international water, sanitation and hand hygiene (WASH) protocols at multiple levels of the healthcare system, helping to reduce maternal mortality.
Padula et al. 5 point out that hospital practice guidelines can sometimes clash with one another and argue for prevention guidelines, such as for pressure injuries, that optimize overall outcomes for patients.
Hannawa 6 proposes a new communication framework that can be used to help healthcare workers talk to one another, and to their patients more effectively, and avoid compromising patient safety.
Countries all over the world that are striving to improve healthcare must take on board major societal trends. With the ageing of the world’s population, and a new imperative for universal health coverage, we cannot do better by working harder; leaders need to invest carefully to achieve goals of improving health and well-being of their populations. It will be crucial to add patients and families to the healthcare team. They are fundamental players in people-centred health services delivered under universal health coverage.
We look forward to the 4th Global Ministerial Summit on Patient Safety, to be held next spring in the Kingdom of Saudi Arabia.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.