A conceptual presentation of a abstract published in Health line- The journal of Indian association of preventive and social medicine ,Gujurat chapter,vol-3,March-2012 and also presented at PRISIM-2012, National conference on Hospital management-2012,Organised by ARVIND eye hospital,Madurai. THIS PRESENTATION MAINLY FOCUS ON HOW TO CREATE A CULTURE OF PATIENT SAFETY IN INDIA'S PUBLIC HEALTH CARE INSTITUTIONS BASED ON A NON INTER VENATION EXPLOITATIVE STUDY DESIGN.

1. Patient Safety In Public Health Care
Institutions
A Conceptual Postmortem
&
Critical Analysis
Clean Care is Safer Care
By.
Dr.Gyanaranjan Pradhan(PGDHM*)
drgyanaranjan@gmail.com
Dr. S.Yasobant (MPH *)
dryasobant@gmail.com
* Pursuing

2. Content To Be Covered
Patient Safety In Public Health Care institutions
 Objectives of presentation.
 What is patient safety?
 Public Heath Care Institutions in India.
 Patient Safety and India.
drgyanaranajan@gmail.com dryasobant@gmail.com

3. Content to be covered
Patient Safety In Public Health Care institutions
 Conceptual Postmortem of the issue :Factors
Responsible.
 Result of Postmortem: Explore Various Dimensions Of Patient
safety.
 Critical analysis :Frame Work To Increase Patient Safety
 Conclusion.
drgyanaranajan@gmail.com dryasobant@gmail.com

4. Objectives of presentation
Patient Safety In Public Health Care institutions
 To know how unsafe our patients are.
 Explore the hidden factors of patient safety along
with most common factors
 How to create a culture of patient safety
 Managerial suggestions to overcome
drgyanaranajan@gmail.com dryasobant@gmail.com

5. How much unsafe our patients are?
Doctors Are More Dangerous than Guns In USA…..
Patient Safety In Public Health Care Institutions
 Number of doctor:  Number of gun owners:
70,0000 80,000,000
 Accidental death due to gun
 Accidental death caused :1500
by doctors per year:
120,000
 Hence Accident Per Year
 Hence Accident Per
Per Gun:0.001875*
Year/Doctor:17.14 *
*Curtsey USA dept. Of Family
Welfare. *Curtsey FBI
Conclusion: Doctors are 9000 times dangerous than Gun

6. How much unsafe our patients are?
Health Care Industry is one of the Risk Industry….
Patient Safety In Public Health Care institutions
Fatal Iatrogenic Blood transfusion
adverse event
Cardiac Surgery
Charted flight
Himalaya
Medical Risk
mountaineering Total Commercial large
jet aviation
Micro light aircraft Road Safety
Railways
Chemical Industry Nuclear Industry
Very un safe ..... Risk ….. Ultra safe

7. What is patient safety?
Do no harm 1st corner stone of medicine…
Patient Safety In Public Health Care institutions
 The prevention of errors and consequence
adverse effects to patients associated with health
care . (WHO)
 Health care error : At various level ;At various
aspects
From managerial………...To Clinical
Human Cause…………….To Instrumental
Policy Failure ……………...To System failure
drgyanaranajan@gmail.com dryasobant@gmail.com

8. What is patient safety: Various dimensions
Freedom from accidental injury……
Patient Safety In Public Health Care institutions
Medicine error Surgical error
Treatment
Physical enviourment Transfusion (blood
accidents & fluid)
HAI
Diagnostic
Health
care error
Communication Equipment

9. Three tier health Delivery model in India
A great challenge for patient safety
Patient Safety In Public Health Care institutions
 242 Medical colleges
 205 Dental colleges
 3,346 CHC
 4,400 DHC
 23,236 PHC
 1,46,026 Sub centre
Ref.k.Park20th ed.

10. India‘s health care paradox
For why patient safety is a ”?”
Patient Safety In Public Health Care institutions

11. Patient Safety and India: legal aspects
Health to all or safe care to all?
Patient Safety In Public Health Care institutions
 No direct legal frame work: Constitution not
provide special right to patients.
 Sec-304 0f Indian penal code 1860: Space to complain
against physician for negligence.
 IMC professional etiquette and ethics regulation :
Address the issue
 Consumer act :Use some time

12. Patient Safety and India : Current scenario
Time to think and progress
Patient Safety In Public Health Care institutions
 At corporate /private hospitals: Quite promising but still
need more attention to create patient safety as a culture
 Our focus public health care institutions: Not only
disappointing but also a headache for all stake holders
 Over burden the system: By increase visit to hospitals, burden
of disease, out pocket and public spending , longer bed occupancy&
queue in OPD.
 Reduce faith on public health care system and growth of parallel
market.
 Vision gradually turned in to rhetoric or a utopian appeal-because
something lack to
Vision Reality

13. Back ground of study : Just give a overview
Thanks to all who cooperate us
Patient Safety In Public Health Care institutions
 Non-interventional-explorative study
design
 Total number of public health care
institutions cover:
1.Sub-cetre and Anganwadi: 6
2.PHC:6
3.CHC:4
4:DH:3
drgyanaranajan@gmail.com & dryasobant@gmail.com

14. Postmortem of Patient safety
Funny but a necessary
Patient Safety In Public Health Care institutions
Public health care Institutions
Overburden
Collapsed
Patient safety venerable
Death of patient safety in these organizations

15. Why postmortem: Explore the cause
Not a natural death
Patient Safety In Public Health Care institutions
The death is suspected due to
 Individual causes :Health care professionals and other
supportive enviourment
 System causes : The health care delivery system and
work process
So there is need to find the exact cause
By
Conceptual postmortem

16. The Procedure of postmortem
should not be biased
– Patient Safety In Public Health Care institutions
Open eye observation:
Silent data collection
Interactingwith various
stake holders of system
Secondary data Sources
drgyanaranajan@gmail.com & dryasobant@gmail.com

17. Findings of Postmortem
You may not belief but true
Patient Safety In Public Health Care institutions
Number of issues :Represents interlinking factors
Various dimensions of factors: Multi facet interaction
Most common highlighted causes : Mask the root
causes, So difficult to Addressed
 Already well focused :But seems to be a nightmare.
drgyanaranajan@gmail.com dryasobant@gmail.com

18. Current Scenario :We all know
Valuable clues towards solution
Patient Safety In Public Health Care institutions

19. Critical analysis of Findings
Not criticism but finding
Patient Safety In Public Health Care institutions
Issue-1:Human Resource: It’s dimensions
Beehavioural
Lack
Inadequacy and change and
Competency
Inequitable poor attitude
related to
distribution towards patient
patient safety
safety
Required some special strategy to address

20. Critical analysis of Findings
Only findings are not enough
Patient Safety In Public Health Care institutions
Issue-2.Work Culture: Various dimensions
Lack of team
Un-supportive work Not people
Work Centered
&
enviourment work culture
Leadership
Required some special strategy to address

21. Frame work to increase patient safety
some hopeful suggestion
Patient Safety In Public Health Care institutions
Create a culture of patient safety in public
healthcare institutions: focus on system issues and
individual issues.
De-centralization of organizational structure and streamline
the management process.
The administrative power shifted from medicos to medicos
specialized in healthcare management.
Allotment of resources and its proper distribution

22. Conclusion
Not possible to conclude still we are not achieve the Goal
Patient Safety In Public Health Care institutions
From Too Much Zeal For The New
And Contempt For The Old;
From Putting Knowledge Before Wisdom
Science Before Art
Cleverness Before Commonsense
From Treating Patient As a Case
And
For Making Cure of Disease More Grievous
Than The Endurance Thereof ;
Good lord Deliver Us
By: Robert hutichison

23. Thanks to all
Join Hands Creating a culture of patient safety
Patient Safety In Public Health Care institutions
Special Thanks
To
Prisim-2012
&
You!!!!
drgyanaranjan@gmail.com & dryasobant@gmail.com