Healthcare delivery


1. Affirm patient safety as a core patient right. 2. Identify the key rights that healthcare leaders and health workers are entrusted to uphold when planning, designing and delivering safe health services.


3. Promote a culture of safety, equity, transparency and accountability within healthcare systems.


4. Empower patients to actively participate in their own care as partners and to assert their right to safe care.


5. Support the development and implementation of policies and procedures that strengthen patient safety.


6. To create a foundation for recognising patient safety as a basic human right.


It is interesting that the charter has been drafted in the overall context of human rights. The charter is comprised of sixteen different standard statements with a range of overarching themes which are related to human rights. It remains to be seen how the feedback from WHO regions and Member states impacts on the final document. This author finds it very difficult to suggest any major changes, as the document is comprehensive and focused on many aspects of care which should be upheld by all professionals and facilities providing care, wherever in the world it is being delivered. Cultures have different layers of respect for different people, generations, women, various tribal hierarchies and all of these will have an impact on how the rights in the patient safety charter affect


Relational aspects


Emotional and psychological support, relieving fear and anxiety, treated with respect, kindness,


dignity, compassion understanding Participation of patient in decisions and respect


and understanding for beliefs, values, concerns,


preferences and their understanding of their condition


Involvement of and support for family and carers in decisions


Clear, comprehensible information and communication tailored to patient needs to


support informed decisions (awareness of available options, risks and benefits of treatments) and enable selfcare.


Transparency, honesty, disclosure when something goes wrong


Table 1. Identifying aspects of patient experience 16 www.clinicalservicesjournal.com I January 2024 Attention to physical support needs and


environmental needs (eg. clean, safe, comfortable environment)


Coordination and continuity of care; smooth transitions from one setting to another


While Martha’s rule is a current campaign, a systematic review in 2012 identified that patient experience is positively associated with clinical effectiveness and patient safety. The review supports the case for the inclusion of patient experience as one of the central pillars of quality in healthcare.


the treatment of patients and, therefore, their experience.


Culture change One of the key aspects of the hierarchies in healthcare, and core to the culture of the NHS and other healthcare providers, is the power imbalance between healthcare professionals and their patients. Merope Mills’ insights into health system weaknesses is detailed and shows many flaws requiring change. The hierarchy, a lack of continuity of care, inadequately trained staff, unwillingness to identify and acknowledge mistakes, and a failure to listen to patient and family concerns are all highlighted. She suggests that the imbalance between health professionals and patients as the major factor behind unsafe care.6 However, as a plethora of articles in this healthcare journal and many others can testify,


Functional aspects


Effective treatment delivered by trusted professionals


Timely, tailored and expert management of physical symptoms


changing the culture in NHS organisations is challenging. There is good evidence that the greatest influence on organisational culture is the quality of leadership, affecting patient outcomes and staff experience. The Long Term Plan for the NHS focuses on the triple aim to improve care, health and costs. But shifting the culture to deliver these goals to where it needs to be will take time and a huge and relentless investment from leaders at every level and in all sectors of the system. It is recognised that the system is enormously complex and needs to have a level of compassionate leadership to facilitate the level of change that is indicated. Mary Dixon Woods and colleagues7


undertook


a huge multi-method study to examine the culture and behaviour in the healthcare system. They found a large number of ‘bright spots’ of excellent caring and practice and high-quality innovation, but also many inconsistencies. They suggest that consistent achievement of high- quality care was challenged by unclear goals, overlapping priorities that distracted attention and compliance-oriented, bureaucratised management. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. For any cultural change to take place in these


organisations, requires significant change. The study showed that when staff had access to appropriate resources, perceived that staffing levels were adequate with the right skill mix, and had systems that functioned effectively, they felt they could complete their work successfully, could explore new ways of improving quality, and could develop reflective practices. This reinforced their levels of motivation and morale in a virtuous circle. But deficits in the system often obstructed and frustrated well motivated


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