Is ‘zero harm’ possible? A Singapore hospital’s story

The Chief Risk Officer of KK Women’s and Children’s Hospital shares her experiences in promoting a culture of safety.

What are the real-life consequences of unsafe care? In high-income countries such as Singapore, one in every ten patients is harmed while receiving hospital care – but nearly 50 percent of these cases are preventable, according to the WHO.

Hospitals have the opportunity to create a culture of “speaking up for safety” amongst staff, no matter their level of seniority, says Pang Nguk Lan, Chief Risk Officer and Director of the Department of Quality, Safety and Risk Management at KK Women’s and Children’s Hospital (KKH). This could potentially prevent safety incidents and ‘adverse events’, lead to long-term cost savings, and even save lives.

It is not about pointing out mistakes, Pang notes. Rather, it’s about “helping you see something that you cannot see at that point,” Pang says on the sidelines of Hospital Management Asia in Hanoi last year.

Making patient safety a strategic priority

In 2015, KK Women’s and Children’s Hospital made ‘Target Zero Harm’ by 2022 a strategic priority. This is a comprehensive programme made up of workshops, feedback reporting, and continuous learning and process improvement through town hall meetings.

Part of this initiative was to tackle certain cultural aspects in Asia, where junior members of staff may feel hesitant to share their views with senior management, or those with more experience. “We felt that we needed to bring in a programme to get our staff speak up on their concerns for safety without fear,” Pang says.

The hospital had identified early on that people and culture were essential to achieving zero harm. It worked with an external trainer to conduct patient safety workshops, training staff of all levels on how to tactfully and effectively share their feedback with others. It has also built an online reporting system for staff who are still not comfortable voicing their concerns publicly.

What’s more, the hospital has trained “peer messengers” whose responsibility is to relay any safety concerns from the online reporting system to the relevant people, she adds. “We want people to be accountable,” Pang says.

A post-training survey revealed how 82 percent of hospital staff are now comfortable with speaking up about safety concerns, thanks to these initiatives, according to Pang. These efforts have translated into very real cost savings for the hospital, too. It has saved nearly $200,000 by preventing urinary tract infections caused by catheters.

“It doesn’t mean no mistakes, because we are all human,” Pang goes on to say. “Once you have the mindset of Target Zero Harm, in whatever things we do, we will make sure that any job given to me, I will do it well, in a way that I will make good choices.”

Here is how it works in practice. In 2019, senior patient care assistant Sa’ad Siti Aishah had noticed something amiss when she checked on a patient before an operation. Siti spoke up and shared her concerns with a ward nurse and then again persuaded her to check with a doctor when the ECG results did not reveal anything unusual.

A CT scan was then arranged which showed a blood clot in the patient’s brain – deeming her unsuitable for surgery. “We are not looking for credit or pinpointing other’s mistakes; we are encouraging each other to save lives and prevent harm from reaching our patients,” she said.

Addressing risks together

Another aspect of Pang’s work involves risk management, which is essentially a more proactive way of addressing safety risks. Simply reacting to safety lapses when they happen is “not a very smart way of doing it, because you are just fighting fires, and things will still occur again,” she points out.

The key to risk management is to break down the silos between care teams. This means bringing together doctors, nurses, aides, facility management, environment services, and even administrative staff to examine a specific problem from all sides, Pang says. “When we do risk assessments, we bring everybody together to work as a team.”

These assessments reveal that sometimes, what the staff thinks the patient needs may not be what the patient wants. Take patient falls, for instance: nurses may think that the best solution is to help the patient to get to the bathroom, according to Pang, who spent twenty years as an ICU nurse. But patients may in fact want to be more independent, or may not want to trouble the nurse every time nature calls, she notes.

It therefore becomes a matter of designing a safer environment for the patients: putting in more grip bars and anti-slip mats in the bathrooms, Pang explains. Here is where it is helpful to get insights from the people who manage the facilities.

“It’s quite rewarding because when we gather people together,” Pang goes on to say. “They are able to work together as a team and meet up to the patients’ needs, and meet our staff needs, and also make ourselves safer.”

She believes that “people are our asset”. Well-trained and engaged hospital staff are in fact empowered to “do wonderful things”. This also means creating a purpose and meaning for all staff – showing them how they all contribute to better outcomes for their patients. “Whenever we do anything, we should look at how we could add value to our patients, rather than just doing things as a task,” Pang concludes.

It should be a given for any patient to enter a hospital and expect high quality and safe care. As healthcare advances across Asia, patient safety is fast becoming an essential priority of any provider.

Image by KK Women’s and Children’s Hospital