By Samrina Bhatti, MRPharmS, PGDipGPP, Manager, and Karen Taylor, Director, Deloitte Centre for Health Solutions
There is a universally accepted mantra in healthcare that no one should be harmed as a result of the treatment and care they receive. In May 2019, the seventy-second World Health Assembly adopted a resolution, ‘Global action on patient safety’ and endorsed the establishment of World Patient Safety Day (WPSD), to be observed annually on 17 September. The origin of WPSD is based on the fundamental principle of medicine – ‘First, do no harm’. Today, the global COVID-19 pandemic has highlighted the huge challenges facing health workers, including the heightened risks to their physical and mental health, and associated risk of patient harm. The WHO has therefore selected as the theme for the second WPSD, ‘Health Worker Safety: A Priority for Patient Safety, under the slogan ‘Safe health workers, Safe patients’; and a call to action, ‘Speak up for health worker safety!’.1 This week’s blog celebrates WPSD by exploring how the safety of health workers, is a priority for patient safety.
Source: World Health Organisation – World Patient Safety Day2
What do we know about the risks to staff?
In September 2020, Amnesty International reported that at least 7,000 health workers had died globally after contracting COVID-19. Mexico has reported 1,320 health worker deaths, the USA 1,077, and the UK is ranked third with 649 reported deaths. Amnesty International believes these figures are likely to be a significant underestimate due to underreporting by many of the countries included in the analysis but nevertheless consider that for over 7,000 people to die while trying to save others is a crisis on a staggering scale. It called for global cooperation to ensure all health workers are provided with adequate protective equipment, so they can continue their vital work without risking their own lives.3
In April 2020, at the peak of the first wave of the pandemic in Europe, the European Centre for Disease Prevention and Control reported that in countries with available data, between 9 per cent and 26 per cent of all diagnosed COVID-19 cases were in healthcare workers.4 The pandemic has demonstrated unequivocally that on top of the risk of contracting COVID-19 itself, stressful work environments create risks and challenges for all health workers, affecting both physical and mental health in addition to other occupational health and safety risks.5 These include infection risk, fatigue from working longer hours and heavy workload, insufficient sleep or rest, prolonged work while using personal protective equipment (PPE) which can cause heat stress and skin damage; and a variety of mental health problems, and occupational burn-out, which in turn can lead to errors and unintentional patient harm.6
Research on the eﬀects on mental health from previous pandemics shows that clinical staﬀ, if not adequately supported, are at higher risk of experiencing moral injury and developing mental health conditions.7 A British Medical Association (BMA) survey of 16,000 UK doctors found 30 per cent reporting they are more stressed and burned out than before the pandemic8. Moreover, since the start of the pandemic, most NHS organisations have seen an increase in the need for mental health support among their staff and expect this to escalate as the pandemic continues.9
Amongst healthcare workers, COVID-19 has had the most devastating effects on black, Asian and other minority ethnic (BAME) communities with an increased risk of COVID-19 disease and death.10 An analysis found that, while only 20 per cent of NHS staff are from an ethnic minority background, of those NHS staff known to have died in the pandemic 64 per cent were from an ethnic minority background.11 Consequently, NHS England has required all healthcare organisations to undertake detailed risk-assessments of all staff who may be at greater risk of COVID-19, including those from BAME backgrounds.12
What mitigating actions have been taken?
The WHO and public health organisations in most countries have recommended a combination of measures for infection prevention and control, occupational health and safety and psychosocial support for healthcare workers during the course of the pandemic.13,14,15,16 This includes enabling staff who have health conditions that would put them at high risk to work remotely on non-patient facing activities or to participate in different forms of telehealth services for example. The general risks to staff and patients as a result of COVID-19 and the need for social distancing has meant that those services like outpatient and general practitioner consultations that could be done virtually swiftly moved on-line.17
This accelerated adoption of virtual care, which enabled staff to comply with social distancing measures, also protected them from the spread of SARS-CoV-2 virus. However, many healthcare services can’t be delivered virtually, including those service needed by people with a severe response to the virus and the many people who continue to need hospitalisation or who were being cared for in care homes or by staff providing care in people’s own homes. Here it was incumbent on the employers to improve the management and flow of patients while keeping patient safety as the defining principle for any reorganisations and cope with demand in a safe and cost effective manner.18
These preventive measures include provision of sufficient PPE, redesigning workspaces to allow physical distancing for both staff and patients and consistent and unrelenting adherence to infection control policies and practices.19 Important considerations include regular screening of healthcare workers,20,21 and in the event that a vaccine is available, prioritising health workers for inoculations.
How might the second WPSD, ‘Health Worker Safety: A Priority for Patient Safety’, improve matters?
WPSD rightly highlights the interdependence between the safety of the health workers and the safety of patients. WPSD rightly highlights the interdependence between the safety of the health workers and the safety of patients and points to an increasing body of evidence that shows that healthcare organisations need to consider improving employees’ mental and physical health and wellbeing as well as creating safer work environments when planning interventions to improve patient safety. 22Thus, the safety of healthcare workers is crucial to continuing the fight against COVID-19. Workers and patients alike must speak up when it comes to protecting themselves from unnecessary risks.
To mark WPSD, the WHO has published a new Health Worker Safety Charter ‘dedicated to the millions of health workers fighting COVID-19 across the globe who put themselves and their families at risk to treat patients, deliver essential health services and contain the spread of the disease; to the health workers who have become infected with COVID-19; and to those who have lost their lives in their unstinting efforts to combat the disease’. The WHO urges all stakeholders, including governments, policy-makers, professional organisations, labour unions, civil society organisations, academia, the private sector, and industry, to sign up to the Charter and commit to taking urgent and sustainable action to ensure health worker safety and patient safety. The Charter has five key action areas. These are:
- Establish synergies between health worker safety and patient safety policies and strategies.
- Develop and implement national programmes for better occupational health and safety of health workers.
- Protect health workers from violence in the workplace.
- Improve mental health and psychological well-being of the health workforce.
- Protect health workers from physical and biological hazards.23
The WHO has used this second WPSD to highlight the fact that the COVID-19 pandemic has demonstrated the extent to which protecting health workers is key to ensuring a functioning health system and a functioning society. Moreover how we organise the healthcare workforce today is at the heart of what safe and sustainable care might look like for future generations. Healthcare employers therefore need to prioritise staff safety and protection effectively and continue to establish synergies between health worker safety and patient safety policies and strategies.
An important and necessary next step, is for all stakeholders to sign up to the Charter for patients, their families, caregivers, communities and the wider public to raise their safety concerns and lend their support to protect health care workers. At the same time, professional associations and international organisations need to speak up against unsafe working conditions and violence against health workers, and to conduct capacity building to promote safety and assist in implementing safety standards.