Patient Safety-centered Field Operations
One of the big areas of best practices I address in my book When Healthcare Hurts is the area of patient safety. In fact, the book grew out of my master’s thesis project on patient safety in short-term global health work. If you have read any of the case studies in the book, you know there have been many problems related to medical teams that lack a focus in this area. However, I believe patient safety is an achievable goal in medical missions, even in short-term work. But how? How do we create and implement safe healthcare initiatives in medical missions? There are many ways to improve safety, but all stem from once central concept. Patient safety standards have no international boundaries, maintaining safety standards normally followed in the volunteer provider’s home country is essential.
Many programs orient their patient flow around community health education, general efficiency, and even evangelism with Christian projects. The primary point is that safety has to come first in projects that involve healthcare delivery. Patient safety is best achieved by following patient safety guidelines, clinical practice guidelines, clinical pathways, and other evidence-based recommendations.
Practice only Within Scope of Practice
Maintaining scope of practice and clinical roles is a basic standard for practicing in all countries. Would a radiologist see and treat a patient as a primary care physician in his/her home country? Would an OB/GYN provide primary healthcare to pediatric patients in his/her home country? Would a floor nurse prescribe medications in his or her home country? Of course not, yet these are commonly seen role transitions when medical volunteers participate in global health initiatives.
These types of role transitions clearly do not support patient safety. These questions get to the heart of the common volunteer assumption discussed in an earlier section (i.e., “Something is better than nothing.”). However, one must seriously question that rationale when the something has potential to cause harm.
Staying within scope of practice is not always possible, especially for long-term workers serving in global health. However, long-term workers are in a much better position to assess the need knowing the regional and national healthcare services available. It is rarely appropriate for healthcare professional on a short-term medical team to change roles or do procedures outside their scope of practice.
Safety Standards Apply Everywhere
The overriding practice standard in all global health projects is that patient safety and regulatory standards that a provider is subject to in his or her home country apply wherever that professional practices. Safety standards do not have international boundaries. With very rare exception, if one would not, should not, or could not do it for a patient in one’s home country, one should not do it when providing care as part of a short-term global health initiative. Healthcare students’ scope of practice is also governed under this guideline. That is, whatever their specific level of training allows them to do in their home country with that level of supervision is what they can do during service.
Permission to Practice
It goes without saying that permission to practice as a healthcare professional is required by law in all countries, and appropriate channels must be followed to obtain permission to practice. The specific professions that require permission vary from country to country, as do the procedures. The International Association of Medical Regulatory Authorities (see https://www.iamra.com) has a vision for everyone around the world to be treated and cared for by safe and competent doctors. Their goal is to support medical regulatory authorities achieve best practice. They could help with the credentialing process in the country you will visit.
Partnering permanent healthcare facilities are likely aware of the process to obtain a temporary professional license if needed. Non-healthcare partners such as churches or local pastors, are rarely aware of these processes and procedures. Practicing medicine internationally involves more issues than most local pastors or missionaries know. I remain convinced that most of the problems that arise in short-term medical missions could be avoided if they would do one thing; view their purpose as supporting long-term medical mission work. See Medical Missions 101 article The One Purpose. In later Blog posts we will look at the some other common assumptions that impede patient safety in global health.