Addressing the Barriers and Political Pressures to Safety

Numerous high profile inquiries in UK, Australia, and U.S. reveal subtle and overt external pressures that enable and support unsafe care. Understanding these ‘political’ pressures on clinical service executives to execute a government policy regardless of evidence on quality of care is essential to transforming healthcare systems. This article reviews key findings and recommendations from several international inquiries and identifies how to overcome barriers to improvement. Identifying the barriers that contribute to patient harm in national inquiries shows the important influence of external political pressures. Reviewing the commitment across professions represented by specialty boards, royal colleges, academic medical centers, and professional unions to protect patients is key. Understanding that a culture of blame can affect patient safety in healthcare systems and how they manifest depends on the political and healthcare provision characteristics of each country. Transparency the ability to openly discuss and address opportunities for improvement in the healthcare system are a recurring theme in national inquiries. All stakeholders must be involved at all stages and mechanisms for ongoing, effective consultation and communication should be provided at the local and state levels.