“Europe’s Health workforce crisis is associated with unprecedented levels of fatigue among healthcare professionals, which threatens patient safety and care quality. Yet, the adoption of technologies that could potentially improve this situation has been frustratingly slow,” according to Mirka Cikkelova, General Secretary of the European Patient Safety Foundation EUPSF. What goes wrong in fixing the health system through digitalization?
What was your path to becoming a patient safety advocate?
It led through various experiences in EuroChild, the European Parliament, and ultimately, the European Society of Anesthesiology and Intensive Care (ESAIC), where I was responsible for coordinating the organization of conferences and managing the scientific programs. This is how I became aware of patient safety and met many different, engaged healthcare professionals striving to bring about change. However, I also witnessed the impact on their own well-being and safety.
Coming from Slovakia and still having many contacts there, I am aware of many cases of delayed treatments, incorrect diagnoses, and, unfortunately, preventable deaths. Living in Belgium for many years, a country where patient and family involvement and safety measures are more robust, I feel that my family and I are safer as patients. Although there is always room for improvement, numerous necessary patient safety measures are generally better implemented, such as proper patient identification, follow-up after discharge, screenings, and prevention programs.
My passion for patient safety comes from this contrast and my desire to embrace complexity, understand people’s motivations and behaviors, think differently, and drive high-quality work. Growing up as a scout leader, I still strive to live by a simple principle: “Try and leave this world a little better than you found it.”
Delayed treatments, incorrect diagnoses, preventable deaths – is patient safety at risk in today's medicine?
It's no secret that healthcare systems across Europe face multiple crises and challenges. Patient harm is an urgent public health issue, and patient safety is a shared challenge across Europe. Alarmingly, 1 in every 10 patients experiences harm while receiving services in a hospital. As many as 4 in 10 patients are estimated to be harmed while receiving care in primary and ambulatory settings across OECD countries. More than half of these cases of patient harm are preventable.
These numbers have been concerning for a while. Still, two new factors increase patient risks: a shortage of healthcare workers, especially nurses, which the COVID-19 pandemic has exacerbated, and the growing demand for care due to an aging population and the increasing burden of chronic illnesses.
Let’s talk about the shortage of healthcare workers. Due to demographics and the rising prevalence of non-communicable diseases, the demand for healthcare services is rising while the number of healthcare professionals is limited. How can we, in this situation, secure safe, affordable, and accessible healthcare services?
First of all, we must acknowledge that this is no simple task. The complexity of care delivery is increasing due to several factors, including a large number of stakeholders, the use of technology, and the fragmentation of care. Therefore, we need to match this complexity with a nuanced approach, taking into account and understanding the specific contexts and needs of different stakeholders in care delivery—such as healthcare professionals, hospital managers, patients, the life sciences industry, and insurance companies. After carefully considering their contexts and needs, we should seek convergence and rebuild links by identifying shared interests.
This is how we approach the work at the European Patient Safety Foundation—by bringing representatives from all types of stakeholders to the table, discussing and understanding their contexts, problems, and motivations. From our review of various health stakeholders' priorities, one common driver aligns the actions of all our Affiliates: the improvement of patient safety and outcomes. Therefore, we are convinced that safe, affordable, and accessible healthcare services are possible if we accept patient safety and healthcare professionals' well-being and safety as guiding principles.
The EUPSF claims that approaches to improving patient safety must embrace the complexity of healthcare systems and the interdependencies between processes, technologies, and the human factor, seeking to produce a sustained positive impact. What role do new technologies play in this regard?
Over the last few years, the potential of technology to transform healthcare systems has become increasingly undeniable, especially from the patient’s perspective. For example, telemedicine and remote monitoring can help manage chronic or post-operative conditions, while artificial intelligence (AI) and big data can help predict risks and personalize treatments. Virtual reality devices can improve the training of healthcare professionals in surgical and emergency procedures, and medication management systems can ensure the safe use of medication at every stage, from prescription to administration.
While it is crucial to stay vigilant about evaluating and validating these technologies to improve patient safety and outcomes, the progress and potential are so significant that one might legitimately wonder whether it is unsafe or unethical not to adopt some of these technological solutions. However, despite many promises, we still see few tangible results: Why do over 1 in 10 patients continue to be harmed during care, with approximately 50% of safety lapses being preventable?
Leading change in such an environment is sensitive and must be handled accordingly. At the same time, it is also an excellent opportunity to redesign tasks, processes, and the roles of individual stakeholders.
Technologies like electronic health records, which give access to patient data, have contributed to better patient outcomes and, paradoxically, to healthcare professionals' burnout. Doctors are overburdened with administrative work. How can we fix this?
There are many existing technologies with the potential to save time and reduce the burden of administrative work for healthcare workers. However, the uptake and implementation of these technologies have been very slow.
Among the reasons is the outdated IT infrastructure in hospitals, which is often incompatible with these technologies. The time lost using inefficient technologies, like faxes, also limits the availability of healthcare professionals to implement new technologies that could improve the situation. With many healthcare settings facing staff shortages, there is no time left to invest in such tasks. It’s a vicious cycle, especially since implementing new technologies requires rebuilding entire IT systems and processes in hospitals, which necessitates significant investments of time and resources.
We can only address this issue through collaboration, sharing knowledge and resources, and avoiding repeatedly solving the same problems from scratch in each hospital or country.
Which technology are you most excited about?
It’s not about my perspective—I believe that healthcare professionals are best positioned to identify which technologies align with patient safety priorities in their specific settings. They should be involved in discussions about the potential efficiency gains associated with new technologies and how the time that technology frees up will be used. We must listen to them, especially since their well-being is crucial to ensuring patient safety.
Recent surveys – like the one from The Health Foundation – highlight how freed-up time from technology could be used in various ways beyond increasing care volumes. This could include enhancing the quality of patient consultations, allowing more time for critical thinking, or engaging in broader professional activities like training, research, and quality improvement.
We should not either forget about the patient's involvement in this process, as the expected outcome will highly depend on their ability to actively participate in their own care. Their involvement is also crucial to configuring the solution in the best possible way, adapting it to different patient profiles, and addressing issues such as data privacy and quality, digital literacy, security, and lack of trust.
One of the EUPSF's campaigns focuses on fighting fatigue. How big is the problem of fatigue among healthcare professionals?
Fatigue affects the well-being and safety of health professionals with greater intensity and on a greater scale than ever before. This is leading to unseen levels of burnout, mental health problems, and people leaving the profession, endangering the continuity and quality of care in Europe. Let's face it: fatigue is only one of the symptoms of a deep crisis. The working conditions have become increasingly difficult. The limits of what is humanely reasonable to expect from health workers have been crossed. And the COVID-19 pandemic has just made things worse! We are all concerned.
Fatigue is not just a physical burden; it impacts healthcare professionals' daily professional and personal lives, affects their morale, and endangers their and their patients' lives. In the long term, fatigue can lead to burnout and mental health problems, which have reached unprecedented levels in European healthcare.
Physicians experiencing burnout are twice as likely to be involved in patient safety incidents, show low professionalism, and are over twice as likely to receive low satisfaction ratings from patients. The most obvious danger is to their patients, but fatigue can also lead to accidents on the way home when they risk falling asleep at the wheel.
As Dr. Hans Henri P. Kluge, WHO Regional Director for Europe, stated: “The health workforce crisis in Europe is no longer a looming threat—it is here and now. Health providers and workers across our region are clamoring for help and support.”
Together with all supporters of our collaborative campaign, we are convinced that no improvement and resilience can be achieved for healthcare in Europe if we don’t start by addressing the basic physical and psychological needs of healthcare professionals and improving their well-being and safety.
The so-called "iron triangle" of healthcare consists of cost, access, and quality. Trade-offs are necessary, which means that when we improve one or two elements, the third one will be affected. If we want to maximize quality and access, costs will also rise. Is there an out-of-the-box solution for this problem?
The solution is simple but not attractive in our current society: we must stop bingeing on short-termism and believing there is a quick fix for complex problems. Many existing studies suggest that consistent investment in quality, patient safety, and prevention could lead to significant cost savings, especially by eliminating many preventable errors, rehospitalizations, infections, etc.
We know exactly what needs to be done. It just goes against the grain of our society of immediacy and the market that meets all our needs in real time.
Most healthcare systems are built around paying for the quantity of health services provided, not the outcomes and quality. Is it possible to maximize patient safety in such an environment, or should we strive to change how our health systems work?
In these times of multiple crises, any project or work that does not question the existing way of working or strive for a change in processes is just delaying the problem or, potentially, even making it worse. We should use the opportunities that new technologies and innovations offer to reinvent healthcare systems. In the meantime, the lack of quality affects the health of society as a whole and comes at a huge cost.
How do you envision the future of healthcare?
I don't have a crystal ball, and I do not think that the future of healthcare is written yet. It will be shaped by us as a society. I hope we will collectively have the wisdom to remember that health is intrinsically linked to the quality of our environment and living conditions. And that we will let our actions be guided not by personal interests but by the goal of improving our shared well-being. The focus should always be on the common good: health.
Regarding digital innovation, we must remain vigilant about evaluating and validating new technologies with a view to improving patient safety and outcomes. We should never forget that technologies are just tools that must be designed, implemented, and used in a way that genuinely supports healthcare professionals in providing better and safer care to their patients.
