Challenges and Realities in the Spanish National Health Service
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Report of the conference

Eight hundred people from 23 different countries attended the International Patient Safety Conference held in Madrid


This was announced by Elena Salgado, the Spanish Health Minister, in her inaugural address to the Conference, an event that provided the opportunity for presentation of the progress made in patient safety and healthcare quality.
The keynote address was given by Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety, who insisted on the need to reduce the incidence of adverse events by redesigning and strengthening health services.

A commitment to quality in health care. This was the starting point chosen by the Spanish Health Minister, Elena Salgado, in her inaugural address to the Ist International Patient Safety Conference held in Madrid on 15-16 November and in which she declared Spain’s express support for the WHO challenge “Clean care is safe care”, an initiative of the World Alliance for Patient Safety that already has the support of 36 different countries representing 56 million persons.

The International Patient Safety Conference, organized by the Directorate General of the Quality Agency of the Spanish NHS under the title “Challenges and realities in the Spanish National Health Service”, brought together 800 healthcare professionals, including both speakers and attendees, from 23 different countries. An indisputable success that provided a forum for sharing of the progress made and strategies developed in different parts of the world with a central objective, namely to improve patient safety and reduce the incidence of healthcare-related adverse events.

The speakers at the Conference included one exceptional guest speaker in the person of Sir Liam Donaldson, Chair of the WHO World Alliance for Patient Safety, who expressed his satisfaction at the numbers attending the event, declaring that it was extremely important for the WHO to see what is being done in Spain and to see how 800 healthcare professionals have taken up the challenge. He emphasized the need to abandon the culture of blame, indicating that in the majority of cases, risks or adverse events are caused by system weaknesses and not by healthcare professionals. From his position as a global expert in the field he also highlighted one of the most serious problems currently facing health services, namely hospital-acquired infections; hence the WHO campaign “Clean care is safe care”.

In his address, Sir Liam Donaldson outlined the areas of activity of the World Alliance, which promotes research and the introduction of adverse event reporting systems and develops initiatives for a patient safety taxonomy, indicating that it is essential to find safe solutions to shared problems. The Alliance also works to promote clinical groups and training, and to ensure that patients get a chance to express their views, while the Patients and Patients’ Families for Patient Safety Program allows the WHO to obtain help from families of patients who have died and from patients who have themselves suffered AEs and want others to benefit from their experience. He insisted that work must be done from within the system, but with guarantees, training healthcare professionals to act competently but without simplifying their role, or in other words, systematizing back-up for both the system and the individual.

Elena Salgado, the Spanish Health Minister, highlighted in her address the importance of the work being done by Spanish healthcare professionals in the field of patient safety. “Safety in healthcare is one of the aspects that is most highly valued by patients and their families”, she said, “as well as being a key element of the system due to the costs that may otherwise be incurred”.

The Minister then went on to refer to the steps being taken in Spain in favour of patient safety. Between 2004 and 2005, the Ministry for Health and Consumer Affairs, through the Directorate General of the Quality Agency and together with the Spanish regional governments, drew up the strategic patient safety guidelines that were to form the basis of the National Quality Program launched in 2006 and which provides funding for the different safety policies (training, teaching, education and research). She also referred to the National Study of Adverse Events (ENEAS), “the first picture of this problem in Spanish hospitals”, that was presented in May 2006 at the National Symposium on Adverse Events held in Madrid. The ENEAS is the ninth study worldwide on patient safety and the sixth most extensive in terms of the number of patients included. The study confirms that Spain presents incidence rates similar to those of the rest of Europe, with 9.3% of patients experiencing AEs and almost half of these AEs being preventable. The Minister announced that ENEAS II is now in progress, a study that will facilitate information on the incidence of AEs in primary care. She also recalled that the “Healthcare Professionals for Patient Safety” Declaration was approved at the Symposium, with the support of more than 100 scientific societies, a level of commitment, in the view of the Minister, unprecedented in Spain.

Another of the speakers, Prof. Didier Pittet, Leader of the Global Patient Safety Challenge and Director of the Infection Control Program, University of Geneva Hospitals, emphasized the problem, indicating that between 8% and 12% of all patients in acute-care hospitals in developed countries develop infections. He said that these healthcare-related infections affect millions of people every year and that they have numerous causes, including the care received, the processes followed, economic restrictions and, naturally, human behaviour. He also indicated that we know that some systems are better at risk control than others, and that the challenge faced is to make control universal. He said that there are prevention strategies that can reduce the problem, simple and easily applicable solutions such as hand-washing, and that for this reason the necessary tools must be made available, adding that hospitals must be encouraged by means of the public recognition they achieve for their efforts.

Alberto Infante Campos, Director General of the Quality Agency of the Spanish NHS, spoke of the ambitious National Quality Program introduced by the present government and which has provided a framework for implementation of a series of Patient Safety measures. Thus work is being done to promote a safety culture among healthcare professionals and to design an adverse event reporting system. Moreover, through agreements with the different regional governments, safe practices are being encouraged in eight specific areas and the quality system in the Transfusion Service is being reinforced.

The challenge, in Mr Infante’s view, is to transform the findings of the research and studies undertaken into practical measures, “to ensure that what we have learnt is put into practice”. For this purpose, the Ministry is to fund projects to establish ways to improve the AEs detected, insisting on the need to move away from the culture of blame and concealment and towards a culture of communication. The fact of having a reporting system is, in itself, a quality element, in his view. At present, he explained, “we are awaiting the report on the legal aspects and we are, at the same time, analyzing the systems and experiences of other countries so as to ensure that we choose the most appropriate reporting system”.

Mr Infante announced that the Directorate General would move into two new areas in 2007, on the one hand working with patients to ensure that they become more involved in the process, and on the other with the private sector – given the extensive network of private hospitals in Spain –which clearly cannot remain outside the debate on patient safety.

The experiences of other countries and organizations were also presented at the Conference. Thus Edward Kelley, Director of the US National Healthcare Quality Report, analyzed the quality indicators and underlined the need for these indicators to be standardized and transferred to other areas; in fact this is one of the objectives of the OECD’s HCQI project. In this respect, Orlando Urroz Torres, Director of the Costa Rican National Patient Safety Program, commented on his country’s experience and pointed to the need to establish international relations and to combine efforts to improve results in the field of patient safety.

The Conference also provided an opportunity to learn of different countries’ experiences of Adverse Event Reporting Systems or of different initiatives developed relating to safety in connection with drugs. It also allowed the views of the patients themselves and of the Confederation of Consumers and Users to be heard; persons who have been the end victims of AEs but who have fought to defend their rights and have brought about changes, providing an impetus for improvements in patient safety.

The Conference was attended, for example, by Susan E. Sheridan, Leader of the WHO Patients for Patient Safety Program, who said that patients have much they can teach and that patients and healthcare professionals must work together to create a just and compassionate health service. The speaker, who leads an international network of patients working to improve safety, completed her intervention by reading the London Declaration, a document approved by her organization that is fully committed to safety and to the development of constructive dialogue with a view to achieving, in short, healthcare excellence.