Marketing Division

Prioritising patient safety

Words by Danielle Crisp

Deakin’s first Bhutanese PhD student hopes to improve the understanding of patient safety issues in Bhutan and inform the development of solutions for nations around the world.

We are often told that our health is the most important thing in our lives. So when things go wrong we want to know we have access to suitable health care and facilities. But an alarming statistic suggests we may not receive the treatment we expect. According to the World Health Organization (WHO), it is estimated that up to one in 10 patients is harmed in some way while receiving hospital care in developed countries. This includes countries with the strongest economies in the world, many of which lay claim to some of the latest technological advancements.

Spare a thought for those people who live in developing countries, where the situation is much worse.

According to WHO, at least 50 per cent of medical equipment in developing countries is unusable or only partly usable, often due to lack of skills or commodities. This often leads to patients being misdiagnosed and incorrectly treated, which can result in serious injury or death. Although it is well known that many nations have substandard health care and facilities, surprisingly, patient safety issues in some developing countries – such as Bhutan – are not well documented, defined or understood. This is an information gap that Rinchen Pelzang hopes to address.

His research topic, ‘Exploring patient safety issues and risk management strategies in hospitals in Bhutan’, aims to uncover a better understanding of the patient safety issues in Bhutan and inform recommendations for the development of appropriate, locally-adapted solutions to these issues.

Undertaking his PhD at Deakin over four years thanks to a 2012 Prime Ministers Australia-Asia Incoming Postgraduate Endeavour Award, Mr Pelzang’s interest in this area was sparked by his first-hand experience of the shortfalls in Bhutan’s health care system.

‘I worked for more than 14 years as a registered nurse and midwife in Bhutan,’ he says.

‘I experienced so many short comings in providing quality care to the patients – in terms of patient safety policies, procedures, health care infrastructures, health workers’ knowledge and understanding of patient safety, equipment, drugs, health care resources and so forth.’

Bhutan is a low-income, developing country located in South-East Asia, at the eastern end of the Himalayas. It has a population of more than 670 000 people, with about 70 per cent living in rural areas and more than an hour’s walk from a road.

Mr Pelzang says Bhutan’s health care system faces the same challenges as other low-income nations such as poor facilities, lack of proper guidelines, financial constraints and an acute shortage of health care professionals.

‘Health care services in Bhutan are characterised by chronic overcrowding, understaffing, underfunding (Bhutan is a donor dependent country), and services being perpetually pushed to the limit,’ says Mr Pelzang.

‘Hospital admissions per year have increased significantly from 25 000 in 1997 to 49 831 in 2011. Bhutan has 0.2 doctors and 2.4 nurses per 10 000 people. Further, Bhutanese media reports have recently exposed delays in the treatment of patients due to a lack of medicines, and adverse events due to use of counterfeit and substandard drugs,’ he says.

‘Most importantly, health care professionals are challenged in their ability to deliver safe processes of care and to be accountable for patient safety without proper patient safety policies and guidelines. Provision of quality care is made even more difficult by the reality that Bhutanese health care professionals have received no education on patient safety.’

Patient safety is major concern for all countries but develop dping countries, such as Bhutan, are left particularly vulnerable.

‘Though Bhutan is challenged by the lack of reliable data on patient safety in its health care system, it has been estimated that in Bhutan, as in other developing countries, preventable adverse events probably occur at a significantly higher rate than in developed countries and at a rate comparable with other developing countries. For example, the risk of health care-associated infection in some developing countries is 20 times higher than in developed countries,’ says Mr Pelzang.

Thankfully, the issues associated with patient safety have now been recognised by organisations that can make a real difference. WHO’s patient safety program, which Mr Pelzang’s research is aligned with, aims to coordinate efforts to prevent harm to patients worldwide through policy development and ultimately provide better patient care.

‘WHO has placed strong emphasis on patient safety research and education,’ he says.

‘This involves identifying the nature and extent of the problem of patient safety and addressing the issue of building capacity to find solutions which are efficient, affordable and just. The findings of my study will contribute to improved understanding of the health care systems of low-income countries and processes for tailoring approaches to address quality care and patient safety shortcomings, and identify areas for future research.’

Mr Pelzang’s exploratory research will be conducted in three different levels of hospitals in Bhutan with a broad range of key stakeholders, including senior managers (from the Ministry of Health and selected hospitals), doctors, ward managers, nurses and health assistants. It will explore and describe the policy processes that influence the current function, status and strengths of patient safety and quality care within Bhutan’s health care system, and the nature and extent of quality and safety issues within it.

Mr Pelzang hopes to identify solutions that will benefit his home country and eventually feed into other health care systems.

‘The research findings will be used to inform recommendations for the development of a model/framework for improving safety and quality in Bhutanese hospitals,’ says Mr Pelzang.

While he believes his research is timely and suitable to improve the quality of care provided to patients in low-income countries, it is only a first step towards solving the worldwide issues surrounding patient safety.

‘Improving the safety of patient care will require a system-wide approach, actioned on a broad range of fronts to identify and manage actual and potential risks to patient safety and to implement long-term solutions.’

Find out more about Deakin’s School of Nursing and Midwifery

Rinchen Pelzang Rinchen Pelzang
School of Nursing and Midwifery

According to WHO, at least 50 per cent of medical equipment in developing countries is unusable or only partly usable, often due to lack of skills or commodities.

Deakin University acknowledges the traditional land owners of present campus sites.

30th October 2012