Health care is not without risks. According to the World Health Organization (“WHO”):
• One in every 10 patients in developed countries is harmed while seeking hospital care.
• Hospital infections affect up to 10 of every 100 hospitalised patients.
• Four out of every 10 patients are harmed in primary and outpatient health care.
• Unsafe medication practices and medication practices harm millions of patients and costs billions of US$ annually.
• Adverse events due to unsafe care is likely one of the 10 leading causes of death and disability globally.
• Investment in patient safety can lead to significant financial savings.
There are many aspects of patient safety. This article concerns truth telling particularly with regard to fire safety in hospitals.
The Health Minister stated at the launching of the Patient Safety Day on 17 September 2019 that the “six highest patient safety incidents in Malaysia from 2016-2018 were wrong surgery, unintended retention of foreign body, transfusion error, medication error, adult patient falls and paediatric patient falls.” Structural or organisational causes that impacted on patient safety were not included in this tally of patient safety incidents.
Hospital Fire Safety
Readers may recall the fire at the Intensive Care Unit of Hospital Sultanah Aminah (“HSA”) in Johor Baru on 25 October 2016, in which six patients perished and many were injured.
Parliament was informed, in March 2017, that the Health Ministry carried out fire safety audits, with the Fire and Rescue, and Public Works departments, in 46 public hospitals more than 50 years old.
“Among several fire risks identified were ageing fire prevention systems, dilapidated electrical wiring and installation systems, the installation of medical gas systems which were not according to required standards, and other discoveries which needed engineering systems to be upgraded…A large number of the hospitals were fire hazards and in need of an overhaul, upgrade and repair to be carried out to ensure the hospitals are safe and did not affect its daily operations.”
An independent committee chaired by a former Court of Appeal judge was appointed to investigate. When the report was handed over to the Secretary General, in June 2018, the chairman of the committee made a call for public disclosure of the report which made 23 recommendations.
The Health Minister announced on 25 November 2018 that the report of the fire would be tabled at the Cabinet.
At the time of writing, the report has yet to be made public. In its call for public disclosure of the report, the G25 was reported to have stated that the investigation committee found “serious weaknesses on budgetary allocations and operating procedures related to safety measures and administrative responsibility” and “breaches of the relevant laws.”
Identifying And Learning From Error
Errors that occur in health care can have severe effect(s) on patient safety with the potential to cause more harm or even death. They are an important consideration in upholding patient safety across the entire health care delivery chain. These errors occur at various stages of health care delivery, e.g. facility structure and organisation, diagnosis and treatment, prescription of medication, in surgery, or neglect to address a medical concern.
The principles in the WHO patient safety curriculum module on “Learning from errors to prevent harm” are applicable to clinicians as well as health care managers and policymakers, when and if parties are humble enough to acknowledge.
It would be safer for all the millions of patients who are provided care at the Health Ministry’s facilities, if its staff, particularly the senior management and policymakers, get back to basics.
In yesteryears, when paternalism characterised the patient-doctor relationship, some doctors withheld the truth when they perceived that discretion might benefit a patient. However, there have been substantial changes in truth-telling attitudes, practices, and policies globally with increased patient autonomy and empowerment, as well as technological advances.
Truth, which is the basis of the patient-doctor relationship, is also applicable to the relationship between the Health Ministry and the public. Truth-telling goes beyond providing facts – it also entails humanity.
Sir Liam Donaldson, the patient safety envoy of WHO, asked at the 6th Annual World Patient Safety Science and Technology Summit in February 2018: “Why is it that some hospitals dedicate themselves to transform permanently and some regard it as a sad moment? They have an enquiry report, they try and learn, but underneath their practice, their culture, their ways of doing things don’t change at all. Why such a difference?”
There are advantages to public disclosure of the independent committee into the HSA fire. It would facilitate closure by the families of those who perished or were injured after three years wondering what really happened. They are owed nothing less.
More importantly, other health care facilities, whether hospitals or clinics in the public and private sectors, would learn from it and institute change to improve fire safety. Some of the changes require finances but many require organisational and attitudinal changes, which cost only time and effort.
Whenever investigation reports are not disclosed by the Health Ministry, it inevitably leads to a perception of a cover-up – a term which no one likes. But what alternative conclusion is there?
The Health Minister was also reported to have said at the launching of the Patient Safety Day: “Studies show that speaking up has an immediate preventive effect on human errors and can also help improve technical and system deficiencies as well as to prevent adverse events.”
It is time to walk the talk with public disclosure of the report on the HSA fire.
“Falsehood is so easy, truth so difficult.”George Elliot
Dr Milton Lum is a past President of the Federation of Private Medical Practitioners Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.