Safe Care for Life | World Patient Safety Day 2026

Hello and welcome to Wonker's patient safety day webinar, Safe Care for Life, partnering with people living with NCDS across life's journey. We're so excited that you've joined us today and I am particularly thrilled. My name is Kim Yu. I am a member at large on our Wonkers executive and also liaison to the WHO to the World Health Organization. I have a distinct honor of introducing our president, Dr. Vivana Martinez Bieni, who will share some thoughts as we start this webinar. Vivana, >> good morning, good afternoon, and good evening colleagues and friends around the world. On behalf of Wonka, it is my great pleasure to welcome you to Safe Care for Life, partnering with people living with NCDS across the care journey as we come together ahead of our patient safety day, but also we as we continue our journey as family doctors every day. My thanks to our working party on quality and safety, our special interest group on non-communicable diseases to Kimu our Wonka Wolas and to all our speakers and patient partners and to Dr. Anna Perez who will provide simultaneous interpretation into Spanish. When we speak about patient safety, we often often think about preventing an error at a particular moment. But for fe for people living with non-communicable diseases, safety is not a moment. It is a journey. People may live with diabetes, cardiovascular disease, respiratory disease, cancer, chronic infectious diseases, and multiple chronic conditions for decades. And along that journey, harm can occur when medications are not reconciled, when referrals or test results are lost, when transitions of care fail. On care is designed for people rather than with them. This is where family medicine has such an important role. Continuity itself is a patient safety intervention. We connect the pieces. We follow people over time and we know the person beyond the disease. They are our partners because safe care for life requires continuity, trust, communication and partnership and those are at the very heart of family medicine. Thank you for joining us and welcome you all to this webinar. Thank you. >> Thank you so much Vivana and truly you know everyone round of applause. Um, we know that our patients with NCDS often interact with multiple health care professionals and services over many years and therefore continuity, coordination, communication, and patient partnership really are central to safety. And we're so excited today to have so many amazing speakers. So, I'm going to be introducing them really shortly, but we're going to have a poll right now. And we have hopefully our first question is what is the greatest patient safety risk for people living with NCDs. So if we can have our poll I'm hoping that we can have our poll. Yeah. There you go. Um so I'm going to give you a few moments to get your QR code so you can answer the code answer the question. And once I see a few few answers there, then we'll move along to our next question. So, I'll count down and give you one more moment. And I love all of the introductions that we're getting from our attendees in the chat. Please do um continue to introduce yourselves in the chat. Fantastic. Excellent. So, we're going to Can you see the answers? I'm not sure that we can see the answers, but hopefully we can show you the answers from what what is shown in our poll and we can move to the next question. Apologies. The next question. Are you able to see it? I need to see whether people can see. >> Yes. >> You see the question? >> No. Where is avoidable harm most likely to enter the NCD journey in your setting? So we have choices of prevention, early detection, patient self-care, daily living. You're doing great. I can see the answers coming through. Um, family or community environment, medicines and multiple treatments, referrals, transitions and followup and overdiagnosis, over testing and overt treatment. So, I'll give you a few more moments. We nearly have everyone participating in this. We've got about 61 so far and so far the answer is in prevention um is leading at 29%. Early detection at 22%. Medicines and multiple treatments at 13%. 12%. >> Yep. And then daily living at about 11%. Thank you so much. We'll give you a few moments there to answer. Great. Are you able to see the answers? Yes. Great. Fantastic. Wonderful. So, we're, you know, we can see how important it is um to really look at where the avoidable harms really are when we think about entering the NCD journey. And so I'm really really um thrilled to be able to introduce our next speaker who will talk about patients, families, and communities as partners in safe care. And we have Dr. Ratna Devi joining us from the International Alliance of Patients Organizations. Dr. Devy, would you like to introduce yourself and share your thoughts? Thank you Kim and thank you WA for uh inviting me to this very very important discussion. Um I'm really pleased to be able to share my thoughts and as Kim said I am actually a trained physician but today I'm wearing the heart of a patient uh hat of a patient advocate. I have a lived experience myself of a chronic autoimmune condition and I'm very passionate about patients being partners in in their journey and being able to discuss and um help themselves by being uh partners in the healthcare journey with their physicians. So today I'm going to be not presenting anything but a small story and uh hopefully that will help you understand why it is important that patients, families and communities should be part of uh every discussion and not just receiving instructions. So this is about somebody in my country and as you know India is a very large country with very diverse health care systems and uh very complex uh between very large cities as well as small villages with almost no healthcare. So Rajesh who is a 48-year-old man was um living with hypertension and diabetes for the last 10 years and though he was regular in his checkups he was taking his medicines but he was never prepared for what complications could occur if diabetes and hypertension were not managed. So he thought taking medicines on time was good enough to manage his healthcare and his diabetes and blood blood pressure fluctuated depending upon what kind of stress he was going through. Sometimes he missed his medications but uh he did not always fully think that this was a danger to him until one morning when he was driving home from work he suddenly felt dizzy and a weakness in his left hand. It was just for a few seconds and it scared him because he thought he was having a heart attack. So he rushed to the nearest hospital uh and in India you can go to any hospital. You don't need necessarily have to go to a primary care physician. So he rushed to the near nearest hospital and the doctor checked him wrote a few medicines and then instructed him to come back again if he had a similar episode and Rajes did not worry too much because the doctor didn't tell him he was having anything serious. He just thought it was he was very uh you know tired and therefore he was feeling dizzy. So he went back home. He started his job again and 3 weeks later he woke up at 3:00 a.m. one morning wanting to go to the L and couldn't get up from the bed. So he struggled and he tried to call his wife and he thought he was shouting but there was no sound coming from his mouth. So obviously his wife could not hear him and while struggling he rolled off the bed and fell on the floor and hearing that noise his wife woke up and she then rushed to him and tried to uh lift him up and put him back on the bed and obviously she couldn't do that because he was uh not only not cooperative but he was also quite heavy for her. So she ran to the neighbor and called the neighbor and between the neighbors and herself they took him to the nearest hospital and that is where he was diagnosed as having a stroke. Now while the doctor was taking the history because the doctor wife had run out to the hospital in panic she forgot to take the medicines. So she could not tell the doctor what medicines uh Rajes was taking and Rajes was signaling with his hand trying to say I want to speak but then everybody was trying to tell him just calm down relax you'll be all right they thought he was panicking but he was actually trying to tell the doctor that I had a similar attack about 3 weeks back and this was what was told to me so Rajes survived the stroke but his journey had only just begun. This was just the beginning and I would hear stop and pause and say that patients and families are the first partners in safety. So if the wife knew that you know what are the signs and symptoms of stroke she probably would have uh taken uh some care. Um if Rajes would have known he probably would have been alerted earlier but none of that happened. And after the care was given, Rajes was discharged and he went home with several medicines and instructions. He was also very irritable and often refused to take medicines or food. He complained of pain during physiootherapy and slowed down until his session stopped completely. The physiootherapy center where he was treated was a little far away and it was not possible for his wife to take him there every day. Not only that when he was discharged he was given several medicines and he was asked how many times to take those medicines. So this medicine three times this medicine four times but nobody told them what medicine did what and what prevented uh you know what was the medicine that would prevent his stroke or have or lower his blood pressure. So they had a lot of questions of which medicine was critical and should not be stopped. So in in in the event he was throwing a tantrum. So what medicine was absolutely must and maybe there's a vitamin that could not be given for one day. What happens if he misses a dose? And this was again not to told to them. Who should they call if they have if they have a similar kind of a um attack at home or if he falls down? And several times during his recovery journey, Rajes would choke on his food and h go into coughing episodes. And his wife tried her best to give him liquid food or whatever food he would take, but she was getting frustrated and tired as well. And nobody had told her what kind of food to give him and what would help him recover faster. So they were depending upon traditional knowledge or community knowledge to be able to give him food and what symptoms should they be aware of as warning signs so that he could be taken back to hospital. So the information that was given to them uh during discharge was in a prescription but not in a patientfriendly format that would help them manage their day-to-day activities or day-to-day um management of medicines, physiootherapy, etc. Now in Raja's case, his wife was actually the first person who who identified that something was not right and ran to the neighbor. And since she is the person who spends most time with him, she should have been told about the signs and symptoms of stroke and what to expect, how to manage if there is an emergency etc. But that system did not exist and therefore she was not um aware of this. The second people who came to help were the neighbors. Now the neighbors also had not heard of stroke or their warning signs or what to do in case of an emergency. And this kind of situation is true across most NCD journeys. Patients families should recognize symptoms are the ones who are making decisions about seeking care in an emergency. They are the ones who are managing multiple medicines at home. They are the ones who notice even the tiniest changes in health and they are the one who often identify problems before the health system does. So they certainly should not be treated as bystanders but more more more than the acute care when they are doing their self-management at home they should be the ones who are leading the care by give getting the right information and by being able to reach the care providers. Now in this um what happened was when Rajes was being very very difficult and not willing to do anything at home his wife in frustration took him to a doctor and this primary care doctor instead of asking him the question are you taking the medication on time asked him what how are you managing your medicines what is it that is making it difficult for you to take your medicines and that question started a long conversation so everybody was speaking. His wife was saying he's being difficult. He himself was saying he was having problems swallowing. His father was saying he was he's being stubborn and therefore is not taking his time. So everyone in the family participated. The primary care physician listened patiently and then sat them down and together as a team they decided what should be done, how it could be done, how could Rajes be motivated to take his medications on time, which medications are critical and cannot be missed, which medications are supplements or for other purposes and may be missed if if there are too many medications to be taken every day. And that one single question of are you taking your medications on time? Have you missed anything? Instead of that, what are you doing to manage so many medications after your stroke? How are you managing those medications? Changed the whole conversation. So primary care can turn patients into partners. The doctor then worked with Rajes and the family and to create a practical plan. And most importantly the doctor asked the primary care physician asked okay all these medicines are fine they are meant to take you towards recovery but what is most important to you and Rajes said I want to be back on my feet and I do not want to get another stroke and these two questions were then dealt with the doctor by saying if you want to be back on your feet you have to do your physiootherapy rigorously if you want to prevent another stroke you have to take your medicines every day. So these were questions that were being answered for Rajes not the doctor telling the patient take your medicines otherwise you will have another stroke. So it changed the whole conversation from the person saying okay if I want to walk back again if I don't want to have another stroke what should I do and that answer then convinced him that if he does not put in the effort then he will not be able to walk back early and if he does not take his medications on time then he will he might have the risk of having a second stroke. So and this is what shared decision making looks like. The health care professional brings the clinical expertise but it's the patient who is explaining what they are feeling and the family who is explaining what they are going through as struggles with the patient that actually completes the conversation and brings together a shared decision that is acceptable to both parties to both to the clinician so that they get the clinical outcomes and to the family and the patient so that it fits into the living conditions because not every patient has the same lifestyle or the same living condition or the same economic status. So the three lessons that uh we learned from Raj's journey is patient should be engaged right at the beginning even before the stroke when they had the um the symptoms meaning the risk factors of hypertension and stroke they should be empowered with the right knowledge. So instead of saying I am telling you to take your medicine so you should do it. It should be okay these medicines need to be taken. How do we do this together? and then connect not in bits and pieces but across the care continuum pathway so that the patient doesn't feel as if they are orphaned or that they are left on the wayside once once they are discharged from the hospital and there is a continuous followup that is happening so that in the event that they have another stroke or there is another problem in the house they are caught early enough instead of wasting time trying to look for resources or for the closest hospital so Raj's stroke was a medical emergency But preventing his next stroke is a partnership and helping his recovery is a also a partnership. Therefore, patients are not just the recipients of safe care. They are also partners in creating it. And if you want NCD care to be safe, we have to move from doctor decides, patient follows to patient, family and healthcare team understand, decide and act together because nothing about patient safety should be designed without the patient being a part of it. I'll stop there and we can have a discussion. Thank you so much. >> Thank you so much Dr. Debbie and you know it's such a great story, one that we can all relate to and really you know just thinking about how do we really build that partnership. I really um am am interested to hear from everyone on on uh who's joined us today. And so we're going to have another Zoom question about really what is the most effective strategy for engaging um patients and and their um you know families as safety partners. So we're going to try and deploy our uh poll again and I'm going to give you a few more moments this time to get your QR code so that you can answer the question. And while we're waiting, I will welcome uh some individuals who are joining us. We have Jeremy from We have a lot of It's amazing. I think it it must be medical students maybe. I'm not sure. Uh from the Philippines, Maria from the Philippines. Alana, Riao, Precious, Cassandra, Nia, and I want to thank Dr. Debbie for >> just being here. I know that you've had other webinars with a Yappo um you know and and others. So it's it's really wonderful to to have your input here. Thank you. >> Thank you. Thank you so much. Thank you. My pleasure. >> I am not I am not seeing the responses Diamud. I'm not sure where the responses are but if you could share some of them that would be great. So hopefully someone is able to see the answers. We have 29 of you answering. So thank you for everyone see that we've got communication care effective safe effective safety um communication communication perception relationships education checking strategy explaining support a lot of communication there and I think that highlights and and really you know having that patient care in the center with safety is is really key. Fantastic. Thank you so much. So we're going to move to our second objective and um it's recognizing patient safety risk across the NCD journey. We have uh Dr. Mercy Wangella, a family physician who will be sharing a story and also talking about how do we recognize patient safety risks. Mercy, would you like to introduce yourself? Um thank you very much uh Quinu and uh good morning good evening uh good afternoon um everybody across the world joining us today. So I am a practicing physician from Kenya and currently head the division of primary health care in uh Embu County. And today I would just like to take us through how do we recognize patient safety risks across the NCD journey um from the lens of um from the lens of a a patient and also from the lens of a family. So today I'm introducing you to someone called Amina. She's not a patient but a composite of many patients that I meet every day in my consult. And before the diagnosis, we have we have Am Amina. She's 54. She's a market trader as are many uh of my patients here. And she's also a caregiver at home taking care of her family, her children. So every day when she wakes up, she takes her sweet tea. We call it African tea. Nice mixture of tea and milk and sugar. has a rushed breakfast because she has to get to work and prepare her family. She spends a lot of hours seated and with meals delayed because at work when she's selling in the marketplace, she has no time to take her meals. Occasionally, she buys pain medication at work because she has back pain. And sometimes when she has to refill her prescriptions along the way, her cash runs out because she's a day trader and she tries to stretch out her prescription so that she can ensure she does not miss their dosage because she's been told she needs to take it every day. So when you look at everything Amina is doing in isolation, it might not be as harmful as you would think. But when you combine everything that Amina has to do from the time she wakes up to the time her day ends together, they alter her risk profile in a very significant way. So when it comes to safety along the NCD journey and risks, the whole life is the clinical context. It's not just the visits, it's not just the prescriptions, it's the whole life. what we call the echo biocscho spiritual context. So thinking about Amina, where does she get her food? When does she eat? What's the quality of the air she breathes? Is it a hot day or is it a cold day? Because we know with diuretics that changes how it is metabolized, changes the hydration um uh uh capacity of the patient and can also augment risk to the kidney. Think about where she works. How far is it from her home? Think about her work. What does she do from morning to evening? You find that Amina sits most of the time because she has to sit at her store from morning to evening to ensure she gets as many customers as possible to make money. Then when you come to her biological context, Amina has a multicobility. At 54, she could be getting frail because of the fact that she's sedentary and she's also aging. her renal function could be compromised because of well does she take enough water when she has to sit at her um station at the market all day. Looking at the psychological context there are things that affect and augment risk. For example, what does she think of her disease? Is there issues around are there issues around anxiety, issues around depression? How confident is Amina when it comes to her ability to take care of herself, manage herself and also how confident is she with her physician and the health care system that's supposed to take care of her? Looking at the social context, there are so many risks that Amina could face as well. What is her role in her family? Amina is a single mother with two children. So that means she does not have extra social support, right? She is a caregiver. That means most of the time she's taking care of people more than someone else is taking care of her. Look at her income. Is it enough to sustain her her family and also her medical care, her transport? How far is she from her next um from the health facility? How far is her home from to her home to her workplace? That's the market. And when it comes to language, how well does Amina understand what you're telling her about her risk, about her disease, about her prescription, about her medication? And last and most important of all, the spiritual context, something that we always forget to explore. And when we talk spiritual, we're not only talking about religion. We're talking about her beliefs. What does she believes about disease and health? What is her belief about the interventions and medical interventions that you're presenting to her? Does she believe that they are acceptable? What is her belief? What is her hope in life? Does she hope and believe she'll get better if she does ABCD? So that is something if not explored has what we call invisible risk. familiar routine can over time become accumulated harm. Her taking a sip of her sweet tea once a day, once a month, maybe once a quarter, might not be harmful, but if she is repeatedly taking it every single day because it's the easiest thing she has access to, over time it becomes a risk. So recognizing pattern in behavior across the journey is important. How many times does she come in for her visit? Does she visit occasionally? Maybe she's supposed to come in every 3 months. She comes in every four months instead of 3 months. Supposed to refill her prescription every month. She refills it every one and a half months. So once is a coincidence. Twice that's a red flag. three times. That's a pattern that points towards accumulating risk and has to be addressed for you to be able to expose the hidden risk. Think about habits. Think about self- medication. Yes, her back is aching. Yes, she can take over-the-counter medication, but how often is she taking that over-the-counter medication together with the prescription that she has to take for her diabetes and her hypertension? How many times do competing priorities get in the way of her making her way to the clinic or make how how many times does competing priorities prevent her from refilling her medication? So this is some of what accumulates across the journey as what we call hidden risk and it is our responsibility to ensure that we unmask this risk so that we ensure Amina across her journey does not have anything that is accumulating to result in an incident. Think about automatic refills. Think about target chasing. What is the most important thing that the care team is chasing currently? Yes, you want the blood pressure down, you want the kidney function better, you want the liver function better, but that when you look at it over time can cause risk. How? We have many protocols and different protocols for hypertension, for diabetes, for cardiovascular protection and cardiovascular risk and intervention. So, when you bring all these things together, they can be very harmful. So, a team did a study around a fictional patient who had a multimobbidity, an elderly patient. They looked at all the protocols that this patient is required to follow in order for this particular patient to get better. They realized that if you followed those protocols exactly, not tailored to a particular context, this patient had to take a minimum of 18 different medicines with 19 different dosages. When you look at it, they're following protocol. Protocol is safe, right? But when you bring it into context, it becomes accumulated risk. Think about the system. When this patient comes into the system, when Amina comes to see you, do you have tests you've done that are not tracked? Broken continuity stockouts. She came today, but there was a drug that was not available. You told her to come tomorrow, but remember Amina has to go to work to sustain her family. So, she doesn't come back. There was no owner. There was no definition of come back tomorrow at 8, you'll get the medication or I'll send it to you. So the action failed in terms of follow through. The care cascade is also a safety cascade which I believe Dr. Dr. Dr. Sitta has also mentioned. So when you look at it alone, it does not show you where the risk is. But when you look at the whole cascade and what happens along the cascade, you realize there's a lot of hidden risk. So this was a study done across 44 low and middle inome countries about the care cascade of hypertension. So you have 100 you find people who have hypertension in a particular community. But out of those 100 only 39% were diagnosed as having hypertension. Then you move on to the next step of the care cascade which is treatment. Out of those 39% only 30% get treatment. You move on from treatment to looking at how well are we doing with control and you realize only 10% are controlled. So you realize that across the care casket things are getting worse and risk is increasing in terms of mobility and mortality. So you have to think about the care cascade also as a safety cascade and where you need to intervene. And I'm glad at the beginning most of you when you're taking the poll said where there's potential for the greatest harm is at prevention. When you're doing for example screening when you find someone who is at risk at the prehypertension stage what do you do? because of the people who get lost and then they never get diagnosed and they fall into the 61%. Another thing that we have to think about in terms of risk is the chronic care labels. Chronic disease can hide acute change. Yes, yesterday Amina came in with breathlessness due to acute heart failure. But when tomorrow she comes in, the breathlessness might not be due to the heart failure. It might be due to pneumonia. But because you're thinking heart failure that she already had before or already has because you're thinking angina because of the chest pain, you will not think anything else and that becomes a risk. So you always have to take pause and think, take what we call a diagnostic timeout. What else could this be apart from what Amina already has? What does not fit based on what Amina already has? Who owns each result? For example, yes, maybe the cardiologist is taking care of the angina, is taking care of the heart failure. Who is supposed to own that in that care cascade? Who is supposed to own the diagnostic part, which is mostly the primary care physicians? And sometimes you find that when there's a process breakdown, it is between the patient provider and counter that moment when Amina has walked in and says she's breathless. That is a very important deciding factor on whether Amina goes to the pulmonologist, whether Amina goes to the cardiologist and gets the correct treatment. So we have to take a diagnostic timeout and look critically at what this could be could be. Safety nating as we call it is a very important diagnostic intervention and one that we must always deploy. When it comes to prescriptions, you can have the correct prescription, but it can still be an unsafe plan. As I've mentioned before, this study showed that in order to manage a multimobidity patient who has non-communicable diseases like hypertension, diabetes, heart failure, maybe kidney injury, they need a minimum of 12 medicines with 19 doses each day and 14 lifestyle and selfmonitoring task. Who which patient would be able to do this on a daily basis consistently without harm occurring? So these are just five single disease guidelines put together for this patient. So what must we do here? We must watch for interactions. We must watch for hypoglycemia especially for diabetic patients. We must watch for renal dozing. We must watch for self- medication and any cost related rationing like Amina does to ensure that her medication gets her to the end of the month. And last but not least, treatment burden. Prioritize what is the most important thing right now at this moment so that you prioritize the care and you cascade the care because a safer plan is a plan that fits the person's capacity not one that fits the guidelines. Harm also lives in the gaps because most harm does not occur at during visits. It occurs between visits. Sorry, let me just reshare this. So don't think of harm only as what occurs during the clinical encounter but what occurs in between. If you decide there's a care plan, who owns that plan? It is important to involve the family. For example, who is doing the cooking? Who's doing the meal preparation? Who ensures that Amina takes her medication? Who is watching to ensure that when certain symptoms occur like symptoms of stroke, heart, heart attack occurs, someone can actually identify and report? Because sometimes a patient might not be able to adequately observe their own symptoms, but the family can. So it's important that in plain language the family understands how to recognize and raise the red flags and everyone has a role to play within the family within the care team and also the patient has a role to play in terms of noticing the red flags and coming in for care immediately. And it must be in plain language that a patient understands and a plain language that is very clear to the patient in terms of how do you know it's a stroke? How do you know it's heart attack? How do you know it's you know dehydration? How do you know the differences? Last but not least, this is a uh a 60-cond life safety check. Lif. When a patient comes into the room, explore this to help you unear the hidden risks. Ask yourself and ask the patient what matters most to the patient in this moment. What is it that the patient repeatedly do does across the day across their life that could actually be a risk? What are some of the failure points when it comes to F? Is there overload in prescription, overload at work, overload at home? Right? And last but not least, think about E, which is escalation. When there's a problem, when there's a change, when a hidden risk unarts itself, who will act on that risk, by when and when will we see that change? It has to be properly explored and also properly documented. Ensure you use the family's eyes. of course with the patient's consent. This is what the clinical record usually misses and does not contain and is a very important part of unearthing the hidden risks. Make sure you make the invisible visible because what we repeatedly do becomes either the hazard or the safeguard. what the patient repeatedly does, what the clinician, the clinical team and the care team repeatedly does and what the system repeatedly does becomes either a hazard or a safeguard. One question can reveal the risk the routine has hidden. With that, I thank you for your audience and hand it over to Kim. Thank you. >> Thank Thank you so much, Dr. Mercy. And really, you know, your last statement about making the invisible visible was so important. Um, moving along, I want to make sure that we get through all of our amazing speakers. We have Dr. Andre Rashford uh talking about equipping primary healthcare workers and teams to deliver safer care for NCDS. Andre, would you like to introduce yourself and your topic? Now um hello everybody and hello to everybody joining this webinar live and on the recording uh from this global family doctor webinar from Wonka. My name is Andre Rottford. I'm a family doctor for 35 years and an academic doctor for 26 years with the Irish College of GPS and I'm the Wonka representative of the Irish College. Um due to the constraints of time, I'm going to do a whistle top uh whistle uh fast tour of uh equipping the primary health care health workers and teams to deliver safer care for non-communicable diseases. Um I'm going to particularly focus on safety netting, medication safety, and team-based care. So to do that, I'd like to introduce you to Rose. Rose is a 48year-old mother of five within one with intellectual disability. She lives in a rural area. She has multimorbidity, hypertension, hyper lipidmia, diabetes, obesity and osteoarthritis of her knees and quite relevant to current times she her area has experienced an extreme weather event and so pharmacy deliveries are blocked for one week. She's on medications for diabetes, hypertension, hyper lipidmia, and arthritis. She is due a review of her multimorbidity. But first, how will her primary care professional manage her NCDs during this coming week? So perhaps think about Rose and the patients that she is similar to your patients where you work. And now and and over time, we're really looking at the issues to do with coordination of care for our patients. And with our patients, continuity is key. And for Rose's case, we really are focusing on the patient needs. So, she needs her symptoms to be controlled. But of very important very important to say that many NCDs have no symptoms. So her hypertension and her hyper lipidmia and sometimes obesity will have no symptoms and patients won't complain of symptoms related to those conditions. So we have to screen and we have to set up a system for Rose so that we will be able to screen for her in the coming week and beyond if there's any further delays. So we must safety net our patient. We must reassure and reappraise her medication knowledge and safety, any side effects or interactions she's having, any shortages that we might face and her adurance. And to do that, the uh no doctor can provide uh all of the patient needs in NCD care. We must involve multidisciplinary care where that's available. And that really means coordination of care. That's the best way to ensure patient self-efficacy that is confidence in their abilities uh to manage and self-manage their conditions and for self-management support and of course continuous quality improvement is another layer um which involves efficiency. Efficiency is one of the domains of quality and in Rose's case this means efficient use of resources including medication and including the workforce capacity. So these are two uh constricting issues that may affect our continuous quality improvement and continuous quality improvement can be delivered and supplemented and promoted in your area through our continuous professional development and practiced based initiatives with a clear plan to partner with Rose for interventions. the team are can be involved. Our medication review is important, but all of this sits in the context of Rose's uh environment because her care must be contextbased, person- centered care. Quality of life depends on these nine factors. They're called the 8 + one dimensions of quality of life from Euroat. the references on my final slide. So for our patients quality of life, you can see that health is just one of the domains of their overall quality of life. And the 8 + one, the plus one is their overall experience of life, which is their personal perspectives and the emotions that they have about their life. And these the the the the care provided by the her her main uh primary care professional and the team whether it's practiced based team or a community-based team are all uh supplemented by this contextbased care and by addressing the social determinance of health. So finally the practical and feasible options are the most effective to be implemented for safety and the outcome in terms of patient safety will be maximized optimized when the patient and their carer or family or communities involved. So I've highlighted four areas that we can focus on with our patients. regular reviews of their medication for the patients knowledge of their medication and their experience of side effects or issues to do with non-adherence and most importantly deprescribing where appropriate. partnering with our patients for shared decision making and goal setting. And it that includes literary support for self-management support, safety and quality audits, looking at our clinical data on outcomes, recording patient goals, and following up on the goals which involve behavior change which must be supported. And the final issue that I'd like to raise today is the human factors for safety and quality. And you might say, well, what are human factors? Well, human factors could be called people factors because it focuses on how people interact with each other, within the work environment, within systems, including health systems, technology systems, and tasks. Most of all, it's how people interact with other people to make it safer for our patients. Um, because no health system is 100% safe. No healthcare pathway is 100% safe. So, we all have a part to do to work together to make errors and poor outcomes less likely. That includes long-term system design, responding to workforce issues, and workload capacity. And here are my references that uh I'd like to share with you today of particular relevance to this webinar. Thank you. >> Thank you so much. Thank you so much uh Dr. Rush forward and um we really truly appreciate your words and also you know I love the uh concept of introducing human factors to our audience and making sure that we understand how important and critical it is to really uh understand that on a deeper level. It's definitely a topic that Wonka has been spearheading and talking about a lot. So thank you for mentioning that. Um we will now have Dr. Mona Osman share on objective number four which is building safer systems and supportive environments for people living with NCDs. >> Yes. Uh hello good afternoon good morning. So I'm just sharing good evening also. So I'll be sharing my slides. So now I will move uh to talk from uh if you want from the perspective of the health system and um so my name is Mona Osman. I'm a family physician at the American University of Beirut uh in Lebanon and uh at the same time I'm the chair of the WA special interest group on non-communicable diseases. So um as I said I'll be talking from the perspective of the health system but uh first of all as my colleagues mentioned first that NCD safety is really cumulative. This is a one journey. It has multiple stops if you want. It has multiple points of vulnerability. So u it passes through uh the home, the community, the primary care and this primary care is our role and this is where I think u uh this is the major anchor of of safety for uh uh patients living with NCGs. You have also the the way sometimes they go to specialist to the hospital and then going back to primary care and more. But through through this journey uh there are multiple risks that they can really uh be facing. So for example clinical risks like what also my colleagues mentioned before like missed or delayed diagnosis sometimes medication related harm treatment omission or duplication but sometimes it can be also related to the system per se like for example communication failure loss to followup and poor coordination and also it is might be related to access like for example unavailability of medications some financial barriers or inequitable access. So the longer and the more fragmented the journey the greater the opportunity uh for harm. So how what are the characteristics to make the uh the system a bit or this journey to make it uh safer. Uh so the first important thing is that we should not rely only on persons on champions on memory. It is very important to have a system design that really promotes safety. And some characteristics of this system include the presence for example of standardized evidence-based pathways like having for example treatment protocols like having clear referral referral criteria having a safety net and escalation criteria uh having reliable medication systems. So we have to have always the essential medications available uh to our role to make sure we conduct the medication reconciliation uh monitoring of course for interactions of medications. Uh another characteristic of of the system is to have reliable follow-up and this means having patient registries, having reminder systems and tracking missed appointment appointments and finally having decision support systems that are available uh like for example clinical prompts, risk stratification and uh embedded algorithms within the uh the system which make makes the provision of care really easier and more straightforward and this this slide really is to highlight more the role that we play as primary care physician and primary care as family physician because this is the safety anchor for the patient. So through our you know the characteristics of family medicine providing continuity of care providing coordinated care provided comprehensive care and this will make really the big difference in the care of patients living uh with NCDS. So having making sure that the information is shared, having accessible records, medical records and medication lists and results, making sure that we have safe transitions across the different levels of care, making sure of clear accountability lines in the system, uh knowing who is responsible for followup and uh you know uh making sure that this is done and of course integrating care. So not managing the diseases in isolation but managing them as multimorbidity. Uh so what does a safer NCD system look like is if you can see these are really the characteristics of our specialty. So making sure that this is connected you have this care connected you have a continuous care building a relationship like what Dr. Vana mentioned in the beginning building partnership and other my other colleagues also building relationship uh really being partners with the patients over time uh being proactive this is where the importance of prevention screening you know making sure of monitoring early identification providing a person- centered care and finally having resilient care because NCDs in crisis are very important and this is very important to make sure that this care is not disrupted So care for poor the system is not only within the clinic if you want the safety is not only within the clinic the health facility but it goes beyond and my colleagues also mentioned some of these but I will just you know highlight them again. So you have the the environment starts from home where you have to make sure that the patients can for example you know uh make sure that the medications are kept in a safe way. Make sure that they understand what we're telling them. Make sure that the caregiver is available to provide support whenever needed. The community is to have accessible primary health care to have maybe community health workers peel support. The workplace is another place is is another if you want uh factor playing an important role in the development of NCD and also in making sure NCD especially in terms of availability of healthy food the possibility to do some activities and having smoke-free spaces digital environment is another uh area that is affecting uh uh the the care the provision of care to people with NCDS and of course the uh the policy as a whole the society providing universal health coverage making sure that uh you know we have a safety net for the patients uh making sure that the environment also the clean air uh affordable medications and others. So supportive environments they are the patient safety themselves. um a system uh is not safe unless it is safe for everyone and I think this is very true because um this is the equitable uh provision of care uh because we have a lot of vulnerability uh in different situations like for example poverty, displacement, rurality, disability, low health literacy, digital exclusion, multimobility and others. So it is very important that whenever we design a uh you know a a system and design an intervention for care that it is important to ask ourselves is it accessible to everyone is it affordable to everyone does people understand uh what does what does this mean what we explain to them and uh how to use the medication for example and can we ensure the continuity of care over time um uh also I I would like to mention uh the importance of having learning uh you know systems. So it's not only important to have a system that has everything okay there is no 100% protective system and always you might have some maybe uh incidents or failure somewhere. So what is important is not to prevent fully may of course it's important to prevent as much as possible but sometimes incidents happen. So what is important is really to learn from these incidents to be uh you know to to analyze to redesign to improve measurements and etc. uh to adapt to the errors maybe that they occur that occurred. So it can be an adverse events, it can be a medication error, it can be a diagnostic delay, it can be anything that can happen. So what is important is really to have systems that learn not systems that only punish because punishment punishment and punishing the person who made the mistake does not lead to better health system u because uh again they might do the mistake again and again or other persons might do the mistake. So when we talk about the system or the NCD safety it's important to talk about an ecosystem in general. So it's not only one person, it's not only the doctors, it's not only the health facility. So you have all of these uh uh factors or if you want participants, shareholders if I can say or partners uh that should be there taking care of people living with NCD. So you have to have people patients empowered and their families empowered. You have to have a supported health workforce, a strong primary health care system, integrated care and safe transitions. You have to have reliable medications, a learning health system, supportive environment and communities and of course enabling policies and social protection. So I want to leave you with a with a pneummonic that we can all remember to make sure that we have provide NCD uh safe NCD to our patients. First we have to make sure that our systems are designed for safety. Make sure that you have in your health health facilities standardized pathways, medicines, availability, diagnostics and monitoring systems. Make sure that it is accessible and equitable to all. It is inclusive care that we provide. Make sure of the followup and the continuity. If patients are not coming, call them uh coordinate the care that they are, you know, the coordination of the transition of care. uh have enabling environments at homes, at communities, workplaces, no blame culture, learning culture, learning health systems, have connected care throughout all the levels of healthcare and of course data is important for improvement. We need to measure, monitor and of course identify gaps and act. So a safe care for life requires safe systems for life and these are my references and thank you very much. Thank you so much, Dr. Osman. And um I love that acronym that you had at the end. It's really excellent. And we'll try and make sure that we uh keep that in our minds. >> Next, we will have our presidentelect uh Par, would you like to share your slide? Sorry, I was in mute. And good day to all. I'm Pastier. I'm a family doctor in Spain. I'm a current WA president-elect. A pleasure to have you all here increasing awareness on the key role of family doctors providing a safer healthcare to people. So as my previous colleagues explained through very nice esttories Bratna Mercy Rose and then Mona patient safety is not only what happens inside our consultation rooms inside our health centers is the patient life journey. So now we are going to sum up and connect risk and proactive strategies. We have to move to proactive strategies. So we are going just to advance in h to the personal daily life that the main reasons they mentioned with the histories was about misinformation and self self medications incorrect device use missed warning signs of um Bradna mentioned for example hypoglycemia or the signs of a stroke and then how we strategically proactively we teach back self monitoring support and advice uh people with red flags and personal safety plan or safety net as Mercy mentioned uh before family and home there are key uh partners medication sharing or unsafe storage sometimes household smoking dietary nerms caregivers trains financial pressure as you mentioned Mona as well and then our proactive strategy is based on concerns by family engagement, agree support roles and safe stories and emergency plans on how to deal with warning signs. But also we we have the patient, we have the family and close caregivers, but we have the community and the environment. Sometimes we live in poor access to screening or unhealthy food environments or pollution and safe p spaces for activity transport barriers. But we need to move for to a proactive strategy with community health partnerships, social prescribing, local screening and referral pathways, supportive environment and multis sectoral action along lifespan. This is key proactive strategy to deal with NCDS and having good health outcomes. And finally, the priming and the health system and mona highlights that we have some considerable risk regarding diagnostic delay polyarm pharmacy stocks or less lost results. But we need to move to a proactive strategy. We answer with medication reconciliation, safety 19, reliable supplies, continued of care along the lifespan, family doctors we do and the followup. So no one of these levels is optional. We need to merge all together and safety is built h along these four levels with the support of family doctors. So we have here our challenge and the relevance of the role of family doctors among the dealing with uh people with chronic conditions. Thank you. >> Thank you so much um Dr. Aopinia for your words and your service as well and just thank you for your many years of of work on patient safety. So thank you for sharing those remarks. Um I do want to move along to our panel discussion with our uh chair of patient safety. Um Klaus Claus are you on? >> Yes, I am here. Good good afternoon, good evening, good morning. Um it's lovely to see everybody on this call and also especially a warm welcome to our YDM uh representative from the the the first cohort of the Wonka NCD fellowship uh Neila Arum. Um lovely to have you here as well. Um and and I think after all of these these wonderful presentations, um it's it's it's it's time probably also to to maybe to take a a a pause and maybe have a few reflections um that would also be useful to see if uh because as you have have uh heard today this there are many dimensions to to patient safety in NCD care. Um, and I think we in family medicine and primary care, we have a especially an opportunity to to um to think about our roles as we zoom in and zoom out from these different perspectives. So, yeah. >> Yeah, I would love to hear, you know, just in terms of WKA's work on NCDs and um patient safety, you know, what are we doing? We've got this NCD fellowship and uh Nila Aroina. >> Um are you >> Yes, I'm here. >> Thank you for helping me. >> Don't worry. >> Um tell us a little bit about your project. >> Sure. Uh well, good morning everyone. My name is Niko Sea. I am a family medicine physician from Panama. Um today I would like to share um a small part of my project that I'm developing in primary care focused on sarcopenic obesity and particularly recognizing um this condition um I would like to share with you I'm sorry why we need to recognize this condition and it should be considered an important component of patient safety in the management of non-communable diseases. When we care um for patients living with obesity, our attention usually is focused on the body weight, BMI, cardiovascular risk, diabetes, hypertension and other cardomabolic complications. However, body weight does not tell us the whole story. A patient can have obesity and at the same time had a reduced muscle mass with a decreased muscle strength that will cause an impairment to um the physical performance. This combination as I know you know is called psychopenic obesity but usually it remains unnoticed and there is where I believe patient safety becomes particularly relevant. Um my project is being developed on primary care setting in Panama and focused on the early identification of people at risk for sarcopenia and sarcopenic obesity particly particularly among patients with obesity and other NCDs. This project begins with a community screening setting activities. Rather than just assessing the BMI, we would like to incorporate simple measure measures of muscle health and physical function that we can realistically can be um can apply on our consults on our everyday consults. Patients identified as risk can then um well in the after the screening will receive an intervention of three months a 12 weeks intervention when we will work with nutrition and um physical therapist to try to develop an intervention to improve not only their muscle strength but also to reduce the BMI um trying to u contribute in the good care of the entities that these patients will have. So the goal is not only to improve their physical health but also to preserve the muscle m the muscle mass strength the function and of course the independence and this is why it is important for patient safety issue because a patient that can do their work by their own or can be at home without needing extra care is a way what we can contribute to a a patient that is safe at home and with better care at home. So, um that is a little bit of the project I will be developing in the NCDS fellowship. So, if you have any questions, I will be more than glad to answer them. And I really hope that you that I explain myself and the little project that I'm trying to develop. Thank you very much for the space. >> Thank you so much, Nila. And we're just so excited for you and can't wait to hear the results of your project. It's really is um such a special thing that Wonka is doing having these NCD fellowships and I'm just really u proud of the work that you're doing and also the other fellows are doing and um with with our chairs um you know just very grateful for your work. Um maybe we can take one question. We are nearly at time so I'm very very a acutely aware of that but maybe Claus you know um thinking about all of the things that you've heard about what is one thing that's really stood out to you? I I was particularly um encouraged to to to listen also to the patient perspective um and also the the wonderful work that the team has put together in terms of the different angles zooming in to the patient caregiver diad and also zooming out into the health system perspective. Um but I'm also especially encouraged by the young doctor's uh perspective because um as Nila has demonstrated through this fellowship which is a a lovely initiative between uh several working parties within Wanka but particularly around NCDS and and and quality and safety but it has from a design perspective has had the young doctor movement boys and and and ownership in this initiative. Um and so so so so taking the also the perspective of where we are in in in in grappling with the the complexities that our our patients have in terms of the lived realities. Um I think it's it's it's lovely that we as a discipline are are centering our our ethos and al also our approach to safety in NCD care around the relationship and and uh those those core domains of primary care that that really um we know that if those uh those the five C's or where we are now at seven C's maybe um are are not coming together it it really is incremental but also but importantly the flip side is True. If those core domains of primary care come together, then there's also this incremental opportunities to embed safety into these the almost daily seem like like just everyday events, but but they add up over time. And I think that that is the a core thing to to appreciate. >> Well, I I totally wholeheartedly agree. And I know we're at time um at this moment, but we do want to hear one last sort of Zoom commitment question is what is one patient safety improvement you will implement in the next 30 days? We're going to pull up that uh poll again and as we're pulling it up, um I just will say, you know, a few words. So, get your QR code and start answering your question. And while we're as uh waiting for some of those to come up, um I want to thank everyone that's been here. Um we know that safe care for people living with NCDS requires quality and safety at safety at every step of the journey from prevention and early diagnosis to lifelong management. And by partnering with patients, strengthening primary care and supporting health care workers, including our nurses and our many nursing students that have joined us today from the Philippines, we welcome you here. Um, we can achieve safer care for life and we know that safe NCD care really is not created in a vacuum. It's not just in the consultation room alone. It is shaped by the food people can access, the air they can breathe, the support available at home, the information they understand, the medicines they can obtain, and the reliability of every handover and transition of care and followup. Our responsibility is not simply to tell people to make safe choices. It's to work with them, their families and communities to make safe choices possible. From home to community to primary care, everyone really deserves safe care for life. So, I'm not sure if we're able to show our Zoom. Um, love it. So just you know looking at um prevention, the patient always at the center um ensuring that we uh make sure medications and improve um our support to train in make sure we consistently train. Uh sometimes the words get mixed up so it's a little hard for me to figure out which word goes with what but I think you get the idea of always keeping patients in the center making sure that we look at risk and prevention uh medication definitely our nursing um and our uh contacts um making sure that we are always involved in our community and I love what um Pilar says, "We as family doctors, we have a key role to make this journey safer." So, we're not only gatekeepers, but we are safekeepers. It's definitely definitely important for us. So, thank you again. We are at time. I'd like again to thank all of our participants and especially our speakers, Dr. Claus, one person. Um, and we have our president, Dr. Vivana Martinez Bianke, our president-elect, Maria Pilar Athopia. We have um our NCD fellow Nila Ado Samina. >> Is that better? I hope I'm saying your name right. >> Andre Rush for Mona Osman. Um we have Dr. Ratna Debbie. I'm hoping I'm not missing anyone. Um and definitely our WKA secretariat um tim thank you so much for your hard work in putting everything together. Um and our translator Anna Anna Perez, thank you so very much. You came in at the last minute and and held us through everywhere. So we want to share with you again safer primary care everywhere. Join the working party. We have a working party on quality and safety. You can um join via the QR code that you see there. We have regional networks. We talk about human factors. We have standards. We have members um who are um uh physicians and young doctors as well that are um available with two young doctor movement seats now open. And I know we also have our special interest group on NCDS um that you can also join if you we don't I don't believe I don't know if we have the QR code for that but you can definitely um look up the um the information for the NCD special interest group online as well. Uh thank you again and we'll see you next time. And take care everyone and keep giving amazing primary care that is safer for everyone. >> Thank you. Thank you so much. >> Thank you. >> Thank you. Bye. >> Bye. Bye everyone. Thank