Symposium 6 - Patient Safety, Past, Present and Future

Private healthcare is regulated by Department of Health under Cap. 633 and Code of Practice. In addition to strictly compile on the statutory requirement, challenges include governance, financial risk, patient and doctor trust, manpower shortage and upholding professional standard. Developing quality and safety (Q&S) culture with robust infrastructure is vital for sustainable development and maintenance of the private healthcare. Healthcare team with partnership, trust and quality improvement mindset are elements of Q&S culture promoting patient safety, staff wellness and patient/visitor experience. Q&S infrastructure includes 5 components: Quality and Safety Committee (QSC), Quality and Safety Department (QSD), Incident and Complaint management, Credentialing and Hospital Privilege. They are governed by Hospital Management Committee (HMC) and Medical Advisory Committee (MAC). 


Effective collaboration of these 5 components maintain high quality and safe services to patients. For example, QSC and QSD mutually support each other for operation and maintenance of Q&S activities. When necessary, financial and legal experts would be invited for assistance. Certain incidents would be referred to Internal Review Committee and External Review Committee by HMC. Their recommendations would be considered for minimizing future similar incidents or complaints. Credentialing policies on professions are crucial for building a high quality team. Doctors are required to apply for hospital privilege to Hospital Privilege Committee (HPC). Depending on training background and any disciplinary actions, HPC together with HMC and MAC could grant, temporarily suspend and withdraw the privilege. Clinical Audit and Research, and Accreditation and Inspection by external parties are another fundamental Q&S activities. Monitoring and evaluations identify quality gap and facilitate strategic planning whereas inspections by external parties examine compliance on the ordinance and achievement of international standards 


In summary, Q&S is a culture supported by a robust infrastructure. Private healthcare providers should strive to maintain the highest standards of care to build and maintain trust with hospital management, staff, doctors and patients, which will lead to better outcomes for all.

 
Background
To enhance continual improvement of hospital quality and safety, China has launched a Nation-wide Hospital Accreditation System (CN3A) since 1989, those accredited as 3A are top hospitals with excellent quality and facilities. While this attributes to the remarkable improvement in healthcare outcome, it is not internationally recognized. The University of Hong Kong-Shenzhen Hospital, with unique experience in attaining accreditation by both the ACHS and CN3A Systems, was deeply impressed by the comprehensive and meticulous details of the latter. Hence, we initiated the attempt to attain certification of the CN3A System by the International Society for Quality Health Care (ISQua, a unique organization for certification of Hospital Accreditation System).
Methodology for Development
The Shenzhen Hospital Accreditation Research Center (SHARC) was established to accomplish this mission. A team of ISQua, ACHS and CN3A leading surveyors was engaged to conduct an extensive review of our current System and international standards. Basing on the CN3A Standard (2020 Version), key requirements regarding comprehensive risk management, occupational health, underprivileged cohorts, and end-of-life care were added to comply with ISQua criteria. 
Results and Conclusion
The International Hospital Quality Accreditation System (SHARC-IHQAS 2021 Version) passed the assessment by ISQua surveyors with an excellent 97% score. The Standard was officially certified by ISQua in February 2022 and recognized by National Health Commission. This is an important milestone as China now has an internationally recognized System that is based on her own culture, practice and legal requirements. This is an assurance that the quality standard of hospitals certified by this System reach international standards. Not only will this set the standards for hospitals in China (including Hong Kong and Macau), but this experience can be extended to other countries along the One Belt One Road to promote continual improvement in quality and safety.

Healthcare is increasingly complex, with multiple stakeholders, sophisticated treatments and technologically-complicated ways of delivering care. With increasing populations and unprecedented rises in chronic disease, examining effective ways to build networked health systems is essential to help tackle these ‘wicked’ problems. We will deal with the question of why, after decades of improving health care, patients still receive care that is highly variable, frequently inappropriate, and, too often, unsafe. We will also discuss new ways of dealing with those challenges.
Resilience is a construct that defines the ability of a system to adjust its functioning prior to, during or following changes to sustain routine performance under both expected or unexpected conditions. Health systems exhibit resilience through workarounds and trade-offs, with clinicians responding to events or circumstances which effect the everyday flow of work. Staff at the ‘sharp-end’ of care flex and adjust to changes, and don’t always deliver care the way ‘blunt-end’ prescriptivists think they do.
Over 10 years ago, those who were thinking about innovation in patient safety research began to distinguish between trying to make sure things don’t go wrong and trying to make sure things go right. These two approaches came to be labelled Safety-I, where the number of adverse outcomes is as low as possible, and Safety-II, where the number of acceptable outcomes is as high as possible. Safety-I and Safety-II approaches are key to understanding resilience. The traditional Safety-I approach focuses on when things go wrong during routine performance and seeks to apply ‘find-and-fix’ solutions. However, very few people in the past had looked at how often things go right, neglecting to understand the everyday performance which unfolds on the front lines of care. This Safety-II focus seeks to recognise the ability of those at the sharp-end to succeed under varying conditions. 
As we prepare to meet ever-more healthcare demands, we need to examine the properties of healthcare systems which can meet the goals we have for better, safer and more evidence-based care. By applying a Safety-II lens and deepening our understanding of resilient performance we can sharpen our understanding of how everyday clinical work is carried out under pressure in inter-dependent networked systems of care.