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EDITORIAL

Patient Safety a 'Right or Privilege'
Saima Aslam, Paul Barach, Zakiuddin Ahmed

Correspondence:
Dr. Saima Aslam
Assistant Director
Riphah Institute of Healthcare Improvement & Safety 
Riphah International University, Islamabad
E-mail: saima.aslam @riphah.edu.pk

Funding Source: NIL; Conflict of Interest: NIL
Received: July 28, 2019; Revised: August 06, 2019
Accepted:  August 10, 2019

Is Patient Safety a 'Right or a Privilege'? The intention 
while treating patients is always to “do no harm” and 
yet, it does not always turn out that way. Healthcare 
interventions are meant to benefit people and 
promote wellness; unfortunately many times they 
present a risk of harm. Patients still suffer from 
wrong treatment or medications, preventable falls in 
hospitals, hospital acquired infections and many 
other events that are harmful. An international 
report published in 2018, reported that 1/10 of all 
patients suffer preventable adverse events, two 
decades after The Institute of Medicine found that 
98,000 people die in hospitals in the US each year 
because of medical errors that could have been 

1,2
prevented.
Patient Safety has now emerged as a fundamental 

3
concept in healthcare.  It is defined by the Institute 
of Medicine as “the prevention of harm to patients”. 
A growing emphasis is being put on the system of 
healthcare delivery that 1) prevents errors, 2) learns 
from the errors that occur, and 3) is built around a 
culture of safety that supports and enables and 
involves healthcare professionals, organizations and 

3,4
patients.
The history of patient safety goes back more than a 
century. In 1854, Florence Nightingale, a nurse and 
s t a t i s t i c i a n ,  u s e d  e v i d e n c e - b a s e d  q u a l i t y  
improvement to reduce preventable harm in the 
Crimean War. A century later in 1964, Schimmel in 
his paper “The hazards of hospitalization” reported 
that 20% of the patients admitted to the medical 
wards experienced one or more untoward episode 

5
and 10% had a prolonged or unresolved episode.  
The Agency for Healthcare Research and Quality, 
known as AHRQ, was formed in 1989, to produce 

evidence to make health care safer, higher quality, 
more accessible, equitable, and affordable, and to 

6
ensure that the evidence is understood and used.
Patient safety initiatives in the UK emerged from a 
wide set of influences and events during the 1970s 
and 1980s. Finally, in 1999, all chief executives of 
health care trusts were given a statutory duty and 
framework, known as clinical governance, to 
manage and actively promote risk management, 
quality, and safety. This resulted in considerable 

7
progress in addressing patient harm.  Now there is 
much greater awareness to the problem, a more 
reflective approach to error and harm, policy 
initiatives to address safety, a dedicated research 
program, and a more humane approach to injured 

7,8
patients and their families.
There is little information on the existing culture and 

9,10,11
practices regarding Patient Safety in Pakistan.  In 
Pakistan, we need to focus first on assessing the 
culture of care and on creating an increased 
awareness for patient safety among healthcare 
professionals. This will create a critical mass of 
healthcare workers to lead the patient safety 
journey. On a larger scale the healthcare system is 
weak and fragmented in Pakistan. The Government 
is rapidly promoting health network formation at the 
local level, but they rarely provide guidance on how 
to assemble or succeed. There is no central or 
n a t i o n a l  g o v e r n i n g  b o d y  f o r  h e a l t h c a r e  
management. It is primarily the responsibility of 
provincial governments. During the past 5 years, the 
Punjab and Sindh Healthcare commission bodies 

12,13 
have been formed. The commissions have 
formulated local acts known, respectively, as the 
Punjab and Sindh Health Commission Acts. The Acts 
contain a defined set of regulations for the 
healthcare facilities in Punjab and Sindh, 
respectively. The prime aim of these Acts is to 
register all healthcare facilities in Pakistan followed 

12,13,14
by licensing and accreditation.
Some of the specific challenges for Pakistan's 
Healthcare Commission quality initiatives are a lack 
of national healthcare accreditation system and 
integrated national guidelines, policies, procedures 

Department of Riphah Institute of Healthcare Improvement
& Safety Riphah International University, Islamabad



This should include setting minimal standards for 
healthcare delivery, a central reporting and audit and 
accreditation system, as well as mandating patient 
safety education at all levels of healthcare training 
and practice.

REFERENCES:
1. National Academies of Sciences, Engineering, and 

Medicine. (2018). crossing the global quality chasm: 
Improving health care worldwide. National Academies 
Press.

2. Global Priorities for Patient Safety Research. (n.d.). World 
H e a l t h  O r g a n i z a t i o n .  R e t r i e v e d  f r o m  
http://whlibdoc.who.int/publicaton/2009/97892415986_
eng.pdf. 

3. 10 facts on Patient Safety. (n.d.).Retrieved from 
http://www.who.int/features/factfiles/patient_safety/en/i
ndex.html

4. Erickson, S. M., Wolcott, J., Corrigan, J. M., & Aspden, P. 
(Eds.). (2003). Patient safety: achieving a new standard for 
care. National Academies Press.

5. Schimmel, E. M. (1964). The hazards of hospitalization. 
Annals of internal Medicine, 60(1), 100-110.

6. Rockville, M. (March 2018). Agency for Healthcare Research 
and Quality: A Profile. Content last reviewed March 2018. 
Agency for Healthcare Research and Quality. Retrieved from 
https://www.ahrq.gov/cpi/about/profile/index.html

7. Small, S. D., & Barach, P. (2002). Patient safety and health 
policy: a history and review. Hematology and Oncology 
Clinics of North America, 16(6), 1463-1482.

8. Barach, P. (2003). The end of the beginning. Journal of Legal 
Medicine, 24(1), 7-27.

9. Jafree, S. R., Zakar, R., Zakar, M. Z., & Fischer, F. (2017). 
Assessing the patient safety culture and ward error 
reporting in public sector hospitals of Pakistan. Safety in 
Health, 3(1), 10.

10. Shah, N., Jawaid, M., Shah, N., & Ali, S. M. (2015). Patient 
safety: Perceptions of medical students of Dow medical 
college, Karachi. J Pak Med Assoc, 65(12), 1261-1265.

11. Gille, L. (2018). Mycoplasma bovis: Sources of infection, 
prevalence and risk factors (Doctoral dissertation, Ghent 
University).

12. Sindh Healthcare Commission Act 2013. (2015 June 08) 
R e t r i e v e d  f r o m  h t t p : / / w w w . p a s . g o v . p k /  
uploads/acts/sindhAct No.VII 2014. Pdf.

13. Punjab, G. o. (30 July 2010). Punjab Healthcare Commission 
Act 2010. Punjab Gazette, 465-477.

14. h t t p : / / w w w . n a c p . g o v . p k / i n t r o d u c t i o n  
/national_heath_policy/NationalHealthPolicy-2001.pdf

15. Shaikh, J. M., Devrajani, B. R., Shah, S. Z., Akhund, T., & Bibi, 
I. (2008). Frequency, pattern and etiology of nosocomial 
infection in intensive care unit: an experience at a tertiary 
care hospital. J Ayub Med Coll Abbottabad, 20(4), 37-40

on healthcare quality and patient safety which as 
12,13 

mentioned on the patient safety Acts. In a recent 
study Jafree et. al. reported that “nurses” perceive 
the culture in public hospitals of Pakistan to be 
punitive and that individuals are not supported or 

9
made to feel comfortable in reporting errors.  The 
fear and lack of psychological safety is not very 
different in the private sector. Hospital acquired 
infections is one of the highest problems in Pakistani 
hospitals. As reported by Shaikh et. al in 2008, data 
from a tertiary care hospital in Sindh showed that the 
frequency of hospital acquired infections was 29% 
with urinary tract infections being the most 
prevalent at 39%, followed by respiratory tract 
infections 30.1% and blood stream infection in 23.7% 
of patients admitted to ICU. Other infections 
identified were skin, soft tissue, wound and 
gastrointestinal tract infections.
Infection control and prevention measures are 
essential components of quality healthcare quality 

11,15
and patient safety.  Pakistan's first national 
infection guidelines were established in 2006, with 
the help of the National AIDS control program. It was 
noted that hand hygiene is rarely practiced as 

11
observed in government hospitals.  Self-assessment 
of trainee physicians at a tertiary hospital revealed 
t h a t  o n l y  1 7 %  w e re  a wa re  o f  t h e  W H O  
recommendations for hand hygiene and hospital 

11
acquired infection risks.

There are many challenges in addressing the 
national levels of quality and patient safety in 
Pakistan. One way to overcome these challenges is to 
d e ve l o p  re g i o n a l  a n d  n at i o n a l  g ro u p s  o f  
improvement-minded leaders. These local leaders 
can be mentored to build trust and lasting 
relationships, share ideas and expertise, and learn 
from successes of others.
There is an urgent need to address Patient Safety as a 
priority in our system. We recommend funding 
research at all levels of healthcare to address the 
gaps that exist in our system regarding the delivery of 
safe medical care. The Pakistani government and the 
Ministry of Health need to focus on policy 
development for Patient Safety as a national priority. 

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