First do no harm: practitioners’ ability to diagnose system weaknesses and improve safety.

Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyze the complex interactions between resources and tools, the organization of tasks and the norms that may govern behaviors, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the technical and relational skills needed to perform these system diagnostic roles. Some safety challenges need leadership from professional associations to provide important resources, peer support and mentorship to sustain safety work.

WHAT IS ALREADY KNOWN ON THIS TOPIC?
Harm resulting from unsafe care is common and results in significant adverse health and economic consequences in high-income countries.
Efforts to prevent or reduce harms often focus on identifying errors so that their specific causes can be addressed.
More recently, attention has been turned to considering how harms arise as a product of complex interactions in systems.

WHAT THIS STUDY ADDS?
Patient safety is much less well studied in low-resource settings than in higher income settings.
We suggest how concepts being employed to advance patient safety thinking in higher income settings could be usefully applied by practitioners in low-resource settings.
The ability to diagnose system weaknesses should become a core skill for those leading teams, wards, departments or facilities in low-resource settings…more