WMA Declaration on Patient Safety

Adopted by the 53^rd WMA General Assembly, Washington, DC, USA, October 2002,
reaffirmed by the 191^st WMA Council Session, Prague, Czech Republic, April 2012,
and revised by the 73^rd WMA General Assembly, Berlin, Germany, October 2022

preamble

Physicians strive to provide safe, high-quality health and medical care to patients.

Progress in medical and allied science and technology has transformed how modern medicine is delivered in advanced and complex health systems.

Inherent risks always exist in clinical medicine. Developments in modern medicine often reduce risk but may also introduce new or increased risks – some avoidable, others inherent.

Physicians and healthcare organisations should attempt to foresee these risks and manage them to the best of their ability.

Many health services continue to struggle with demand exceeding capacity, often with an inadequate infrastructure due to underinvestment by governments or other providers of healthcare. Patient safety is at risk where physicians work in systems under pressure.

Patient safety is affected by the working culture that physicians operate within. In many healthcare systems there is often a culture of blame, where individuals are targeted rather than examining wider organisational causes of error (such as resource constraints, workforce shortages, or systemic failures).

Many physicians fear being unfairly blamed for medical errors which may have been caused or exacerbated by systemic factors, and often feel unable to be open or raise concerns.

A workplace culture of learning assures and improves patient safety. Embedding a just and learning culture approach can be an antidote to cultures of blame and fear.

In a just and learning culture, the initial focus is on what went wrong when patient safety incidents took place, rather than seeking to determine who may individually be responsible.

Medical regulation and a fear of litigation can compromise physicians’ ability to be open about medical error. A system where physicians feel unable to speak up, due to fear of personal recrimination, will compromise the identification of systemic causes of error or poor care and imped measures to improve patient safety.

Working in a system under pressure that has a culture of fear and blame can erode physician wellbeing. Physicians’ performance in stressful working environments may be impaired, potentially leading to error or poor patient outcomes.

Improving physician wellbeing significantly improves productivity, care quality, patient safety and the sustainability of health services.

Positive cultures within workplaces are vital to minimize medical error, improve physician wellbeing and assure patient safety.

Principles

1. Physicians must ensure that patient safety is always considered during their medical decision-making.
2. Individuals and processes are rarely solely responsible for errors. Rather, separate elements combine and together produce a high-risk situation. Therefore, there should be a non-punitive culture for confidential reporting healthcare errors that focuses on preventing and correcting systems failures and not on individual or organization culpability.
3. A realistic understanding of the risks inherent in modern medicine requires physicians to cooperate with all relevant parties, including patients, to adopt a proactive systems approach to patient safety.
4. To create such an approach, physicians must continuously absorb a wide range of advanced scientific knowledge and continuously strive to improve medical practice.
5. All information that concerns a patient’s safety must be shared with the patient and all relevant parties. However, patient confidentiality must be strictly protected.
6. When medical error or a patient safety incident occurs, investigations should always begin by fully reviewing the wider environment that the physician operates within to identify systemic factors and pressures that may have contributed to the error.
7. Where medical error is found to have been caused fully or partly by systemic factors, any judgement by the regulator(s) should also hold the healthcare providing organisation to account.
8. Regulators of healthcare providing organisations must promote and ensure positive, just, and learning workplace cultures, where physicians and patients feel supported and empowered to learn when adverse events occur.
9. Regulators have a responsibility to identify systemic and contextual constraints that impact on patient safety, including a lack of resources and infrastructure.

RECOMMENDATIONS

Recognizing the importance of system pressures, workplace culture, physician wellbeing, and healthcare regulation on patient safety, the WMA recommends that its Constituent members:

1. promote policies on patient safety to all physicians in their countries;
2. encourage individual physicians, other health care professionals, patients and other relevant individuals and organizations to work together to establish systems that secure patient safety;
3. encourage the development of effective models to promote patient safety through continuing medical education/continuing professional development;
4. cooperate with one another and exchange information about adverse events, including errors, their solutions, and “lessons learned” to improve patient safety;
5. demand that the investigation of medical error and patient safety incidents always consider wider contextual and systemic factors or pressures;
6. demand that healthcare providing organisations foster a culture of learning, support and improvement that facilitates patient safety;
7. work to ensure that the regulation of the medical profession encourages and supports patient safety;
8. support regulation that works to prevent medical error, promoting good practice and learning among individuals and organisations providing healthcare;
9. work to ensure healthcare environments have the necessary resources, infrastructure, and workforce to support patient safety.