Janete de Souza URBANETTO, Luiza Maria GERHARDT


Safe healthcare has been at the core of discussions in the field of health nearly everywhere in the world. On its own or in collaboration with other organizations, the World Health Organization (WHO) has been launching several challenges and guidelines meant to provide inputs for discussions about local circumstances and especially for healthcare institutions to have a starting point to implement and foster imperative, urgent safety measures. The topic is not new. Much to the contrary, it is as old as healthcare itself. However, the importance of healthcare and the high risks associated to it began being acknowledged after the 1999 publication of the US Institute of Medicine report, To Err is Human(1). Last April in Brazil, the Ministry of Health instituted the National Patient Safety Program in response to individual and/or collective entreaties by healthcare professionals and the population at large for safe healthcare free of incidents that may compromise people’s health. In nursing, educators, care providers, researchers and undergraduate and graduate students have been voluntarily rallying since 2008 to create and develop the Brazilian Nursing and Patient Safety Network (REBRAENSP, in Portuguese).
Nearly all Brazilian states have REBRAENSP hubs and centers, which create valuable settings for discussions that impact healthcare, teaching and research practices. For healthcare to be safe, it is necessary to build a culture of safety, which the National Patient Safety Program(2) defines as:
a culture under which all workers, including healthcare providers and managers, take responsibility for their own safety and that of their coworkers, patients, and family members; a culture that places safety above financial and operating goals; a culture that encourages and rewards people to spot, notify about, and solve safety-related problems;
a culture which, after an incident has taken place, fosters education within the organization; and a culture that supplies resources, a framework, and accountability for safety to be effectively upheld. As we can see, the challenges in the way of developing a patient safety culture are massive but not insurmountable, and encompass the need to set effective strategies on three fronts: healthcare professional education, overall healthcare, and research. In education, the topic of patient safety should be included throughout the curriculum and focus on specific risks and measures to prevent harm in the various healthcare scenarios. Patient safety should be addressed by means of teaching-learning actions through which students and educators experience significant practices that lead to safe work in the course of their training and which are sustained into their professional work. To that end, educators need to uphold permanent/continued education strategies, and the teaching projects for undergraduate/graduate and technical programs need clear guidelines so
the safety aspect is not minimized among other important ones in healthcare education. When providing healthcare at all levels, one’s eyes must look beyond one’s own professional practice towards the multiple factors that endanger patient safety in the process of care. All actions become more complex within this scope of healthcare and require intense, coordinated efforts for healthcare processes to be feasible starting from their planning. In other words, regulations, procedures, routines, strategic maps, checklists, and others must be actually implemented to advance safety and impact the quality of healthcare. Another extremely relevant aspect requires changing the culture of punishment that penalizes the professionals and fails to look into the context in which a safety incident has occurred. Such outdated model still guides the actions of many managers and institutions, and ends up leading tothe recurrence of safety incidents instead of to their prevention.

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ISSN 0102-6933 E-ISSN 1983-1447