Clinical Incidence Management

By: Afaal, MD

In the healthcare setting more and more people are treated safely and successfully everyday and there is no exception here in the Maldives.  However, despite the dedication and hard work of the teams of healthcare professionals, in the complex health system things can and do go wrong placing patients at risk or harm. According to international studies, about 10% of patients will suffer an incident during their episode of care at a healthcare setting. In the Maldives, there are no such statistics available to understand the extent of the matter. It is though evident that there are such incidences in the entire healthcare setting here in Maldives as well.

One question that comes to mind is that why don’t we have such statistics? And the answer is very simple. We simply don’t have the mechanisms and the facilitations to identify and manage such incidences. There are many reasons for this. The first and the obvious reason is that, in Maldives any incidence puts the healthcare professional into situation of blame and accusation from the public. The culture is that the health professional intentionally does harm to the patient, which, of course is not the case.

Secondly, there is no protection to the health professionals and health providers through regulation and or Laws. Hence, the motivation for development and implementation of incident management systems are bleak due to the fear of litigation. Especially, the experience in Maldives is that healthcare mishaps are tried as criminal cases, whereas in the established systems, healthcare mishaps are tried as civil cases unless a criminal intent is established.

Established statistics in the world indicate that patient safety incidents are almost always unintentional. The

key to establishing an incident management system in the healthcare setting is to identify and manage such incidences and minimizing all risks to the patient. It is imperative for the creation of a learning culture where the professionals and the institute learn form incidents and near misses. It is used to review practice, train staff and improve their competency, assess equipment and communication gaps and make continuous improvements to the system of healthcare delivery.

There is a need for the Maldives to establish a proper legal and regulatory framework to facilitate risk management strategies such as incident management in healthcare settings. This will be a key factor to improve the quality of services and care provided in the country. There is a need to shift the mind set of the regulatory bodies and the public, as well as those within the health system to do away with the blame culture and move towards a learning culture.

Given the above reasons, we are having a challenge to implement an incident management system and standard here at ADK Hospital. There is apprehension and reluctance among clinical staff to champion a change in the paradigm in which we have been working. Establishing such a system and testing it out can only overcome this challenge. We have to start to gain our confidence by doing it and facing it.

Hence, the ADK Hospital’s clinical incidence management system is now ready for implementation. In the recent past we have used the aspects of this tool to assess some incidents and so far has proven to be satisfactory. With the implementation of this mechanism, we hope to see positive improvement in quality as well as care processes.

The main purpose of implementing this mechanism is to minimize patient harm through identifying and treat hazard before they lead to patient harm, identify when patients are harmed and promptly intervene to minimize the harm caused to a patient as a result of the incident and to ensure that lessons are learned from the clinical incidents and applied through taking corrective actions.