Hu­man be­ings, in all lines of work, make er­rors. Er­rors can be pre­vent­ed by de­sign­ing sys­tems that make it hard for peo­ple to do the wrong thing and easy for peo­ple to do the right thing. Cars are de­signed so that dri­vers can­not start them while in re­verse be­cause that pre­vents ac­ci­dents. Work sched­ules for pi­lots are de­signed so they don't fly too many con­sec­u­tive hours with­out rest be­cause alert­ness and per­for­mance are com­pro­mised.

In health­care, build­ing a safer sys­tem means de­sign­ing process­es of care to en­sure that pa­tients are safe from ac­ci­den­tal in­jury. When agree­ment has been reached to pur­sue a course of med­ical treat­ment, pa­tients should have the as­sur­ance that it will pro­ceed cor­rect­ly and safe­ly so they have the best chance pos­si­ble of achiev­ing the de­sired out­come.

This is a se­ri­ous con­cern in health­care that, if dis­cussed at all, is done on­ly be­hind closed doors. As health­care and the sys­tem that de­liv­ers it be­come more com­plex, the op­por­tu­ni­ties for er­rors abound. Cor­rect­ing this will re­quire a con­cert­ed ef­fort by the pro­fes­sions, health­care or­gan­i­sa­tions, pur­chasers, con­sumers, reg­u­la­tors and pol­i­cy-mak­ers. Tra­di­tion­al clin­i­cal bound­aries and a cul­ture of blame must be bro­ken down. But most im­por­tant­ly, we must sys­tem­at­i­cal­ly de­sign safe­ty in­to process­es of care. Er­rors are re­spon­si­ble for an im­mense bur­den of pa­tient in­jury, suf­fer­ing and death. Er­rors in the pro­vi­sion of health ser­vices, whether they re­sult in in­jury or ex­pose the pa­tient to the risk of in­jury, are events that every­one agrees just shouldn't hap­pen. Er­rors are read­i­ly un­der­stand­able to the T&T pub­lic.

There is a size­able body of knowl­edge and very suc­cess­ful ex­pe­ri­ences in oth­er in­dus­tries to draw up­on in tack­ling the safe­ty prob­lems of the health­care in­dus­try. The health­care de­liv­ery sys­tem is rapid­ly evolv­ing and un­der­go­ing sub­stan­tial re­design, which may in­tro­duce im­prove­ments, but al­so new haz­ards. We must ex­am­ine oth­er qual­i­ty is­sues, such as prob­lems of overuse and un­der­use. The qual­i­ty of health­care in T&T needs im­prove­ment at all lev­els. At some point in our lives, each of us will prob­a­bly be a pa­tient in the health­care sys­tem. It is hoped that pub­lic aware­ness and lob­by­ing can serve as a call to ac­tion that will il­lu­mi­nate a prob­lem to which we are all vul­ner­a­ble.

Dr Stephen Ram­roop

For­mer med­ical di­rec­tor

San Fer­nan­do Gen­er­al Hos­pi­tal