Article Text

Journey of healthcare quality and patient safety in Pakistan
  1. Zakiuddin Ahmed1,2,
  2. Khalid Masood Gondal3,
  3. Javad Akram4
  1. 1Riphah Institute of Healthcare Improvement and Safety (RIHIS), Riphah International University (RIU), Karachi, Pakistan
  2. 2Health Research Advisory Board (HealthRAB), Karachi, Pakistan
  3. 3Fatima Jinnah Medical University (FJMU), Lahore, Pakistan
  4. 4Pakistan Society of Internal Medicine (PSIM), Lahore, Pakistan
  1. Correspondence to Dr Zakiuddin Ahmed; zakiuddinahmed{at}

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Journey of healthcare quality and patient safety in Pakistan is marked by continuous challenges on one hand, yet slow and steady progress on the other. While Pakistan has been struggling with limited healthcare resources and lack of commitment or policy from the government, recent years have witnessed a surge in patient safety and healthcare quality initiatives from all sectors enabling a safer healthcare environment,[1-2].

Before the year 2000, like most other countries, both the government as well as the private health sector in Pakistan did not recognise or prioritise quality and patient safety as a significant component of healthcare. The focus was mainly on treating illnesses rather than providing quality care. Additionally, a realisation about medical errors in hospitals was not present,[1-2]

In the early 2000s, the situation slowly began to change. The first annual symposia on ‘Quality in Healthcare’ at Health Asia Conferences and Exhibition 2004 in Karachi marked the initiation of a formal conversation on healthcare quality and patient safety at a national level. In 2006, the Aga Khan University Hospital (AKUH) became the first Institute in Pakistan to receive accreditation from the Joint Commission International (JCI) leading to setting higher patient safety and quality standards in the country,[3-5]. In 2009, the Health Chapter of Quality and Productivity Society of Pakistan (QPSP) was established which unfortunately discontinued after 2 years due to lack of resources, commitment and financial support. Later on, a larger and more organised national initiative with the name of ‘Healthcare Quality and Safety Association of Pakistan (HQSAP)’ was launched in 2018. In the year 2010 a seminal workshop called ‘Patient First’ was launched all over Pakistan that raised awareness about the importance of patient-centredness as a fundamental of healthcare.

The journey of patient safety and healthcare quality in Pakistan picked up momentum when Riphah International University (RIU), playing a visionary and leadership role, established the Riphah Institute of Healthcare Improvement and Safety (RIHIS) in 2015,[7]. This was the first of its kind dedicated institute of patient safety in the region, which was launched with the mission of creating a reliable health ecosystem that delivers safe and quality healthcare to patients and enables harm-free care with zero medical errors.

In May 2016, RIHIS organised the 1st International Conference on Patient Safety (ICPS) under the theme ‘Patient Safety: Right or Privilege’ which gathered both national and international quality and patient safety experts along with all the major stakeholders,[8-9]. From 2017 to 2023, RIHIS continued to successfully organise the 2nd, 3rd, 4th, 5th, and 6th ICPS, focusing on various themes including ‘Value Based Healthcare’, ‘From Knowledge to Improvement’, ‘Speak Up for Patient Safety’, ‘Implementation Research in Healthcare Quality and Safety’ and ‘Engaging Patients and Families to Co-design Safety’. These conferences, which were co-hosted by leading organisations like Aga Khan University Hospital, Combined Military Hospital, Rawalpindi Medical University, Liaquat National Hospital and Fatima Jinnah Medical University, played a pivotal role in advancing efforts to establish a patient-centric ecosystem in Pakistan. The 7th ICPS is planned to take place on 10–11 May 2024 in Islamabad with the theme of ‘Diagnostic Safety’.

WHO Pakistan office, College of Physicians and Surgeons Pakistan (CPSP), Pakistan Medical and Dental Council (PMDC), National Institutes of Health (NIH) Pakistan, Punjab Healthcare Commission (PHCC), Sindh Healthcare Commission (SHCC), Islamabad Healthcare Regulatory Authority (IHRA), Health Services Academy (HSA) and other leading organisations have been supporting the cause of healthcare quality and patient safety in Pakistan along with endorsing ICPS every year making it the official annual gathering of healthcare quality and patient safety experts.

At each ICPS a Patient Safety Declaration was proposed which was endorsed by all participating organisations and participants. Patient Safety Champion Awards have been given to doctors, nurses, pharmacists, allied health professionals every year who have been championing the cause of patient safety in Pakistan. Similarly, Health Research Advisory Board (HealthRAB) has been giving the ‘Prof. Dr. Tahir Shamsi Patient Safety Research Award’ for best research in healthcare quality and patient safety every year at the ICPS. These conferences have brought several global leaders, domain experts, regulators, academia and other stakeholders working in patient safety and healthcare quality to the country, facilitating the exchange of ideas, knowledge and best practices.

WHO formally contracted RIHIS in the year 2019 with an Agreement for Performance of Work for developing the National Quality & Safety Policy & Strategy and conducting the implementation of the Patient Safety Friendly Hospital Initiative (PSFHI) at leading hospitals across the country. In addition, it also included the development of a report on the situational analysis of patient safety in Pakistan,[10]. This formal initiative of WHO resulted in the Indus Hospital and Health Network and the Tabba Health Institute receiving the PSFHI level 1 status,[11-12]. At present, eight hospitals in Pakistan are implementing the PSFHI,[13]. WHO country office has contributed significantly to establishing healthcare quality and patient safety in Pakistan by launching the PSFHI, celebrating World Patient Safety Day with strategic partners like NIH, RIHIS and others, organising the Patient Safety Technical Working Group workshops with the Ministry of Health, supporting ICPS every year, and commissioning the National Framework on Patient Safety and Quality of Care.

An important landmark in the journey of quality was the creation of provincial health care commissions. Punjab became the first province to lead this initiative and formed the PHCC in 2010 after which Sindh, Khyber Pakhtunkhwa, Balochistan and Islamabad followed suit. These provincial and federal health care commissions developed their own minimum service delivery standards which require all healthcare facilities and providers to register themselves and comply with these standards. These health care commissions significantly contributed towards standardising and improving the quality of care in Pakistan.

Shifa International Hospital in Islamabad, which became the second hospital to get accredited by JCI in 2017, is also one of the leading institutions in Pakistan that has contributed significantly in healthcare quality and patient safety. Shaukat Khanum Cancer & Research Center earned JCI accreditation for its hospitals in Lahore and Peshawar in 2018 and 2019, respectively. AKUH established its Center of Patient Safety in 2020, keeping in line with its history of adding value to the journey of quality care and patient safety in Pakistan.

In the year 2019, RIHIS entered into a Memorandum of Understanding (MoU) with medical universities across Pakistan and in 2020 it established the first two centres of patient safety at Dow University of Health Sciences (DUHS) and Jinnah Sindh Medical University (JSMU). These efforts were followed by a significant milestone when NIH Pakistan developed and launched National Guidelines for Infection Prevention and Control and inaugurated a Center for Occupational and Patient Safety (COPS) which provides strategic guidance to healthcare professionals, enabling transformative changes in the often-neglected area of patient and occupational safety,[14]. Supported by RIHIS as part of the MoU between the two entities, this centre plays a pivotal role in advancing healthcare quality and patient safety standards.

AKUH and Islamic International Medical College (IIMC) of Riphah International University (RIU) became the first two medical colleges which included patient safety in their undergraduate curriculum by using the WHO and Institute for Healthcare Improvement modules. Peshawar Medical College also followed suit and introduced patient safety in its curriculum. Later on PMDC recommended patient safety to be taught in all medical colleges which facilitated the nationwide adoption of this discipline,[15-16]. Jinnah Sindh Medical University also developed a curriculum, with the help of AKUH and RIHIS, which is being taught at all its constituent medical and dental colleges in Karachi.

In 2022, RIHIS took the initiative and led the formation of a Regional Consortium of Patient Safety (RCPS) which includes experts and leaders in patient safety from 18 regional countries. In August 2022, the first meeting of RCPS was organised by RIHIS in collaboration with the Institute of Global Health Innovation, Imperial College London.

In Pakistan, there has been ongoing advancement in raising awareness and conducting research on patient safety and healthcare quality. Leading this effort, RIHIS launched the first dedicated journal focused on patient safety, titled the Journal of Healthcare Quality and Safety (JHQS),[17]. Following this milestone, RIHIS partnered with BMJ Open Quality to launch the BMJ Open Quality Riphah Pakistan Edition,[18].

The journey of patient safety in Pakistan stands as evidence of the steadfast commitment of numerous individuals, institutes, societies and organisations. However, the quest for patient safety remains ongoing and is never truly over. As we celebrate these achievements let us view them as the foundation for building a safer healthcare system. Let us all, patients, healthcare providers, policymakers and educators, commit ourselves to creating a healthcare system in Pakistan where every patient feels safe, valued and well-cared for.’

About this issue

This first-of-its-kind collaborative initiative between BMJ Open Quality and RIHIS provides a platform for encouraging and publishing relevant and local research from a low-middle income country focusing on various areas of healthcare quality, improvement and patient safety. This dedicated research journal will not only foster a culture of patient safety and healthcare quality in Pakistan but will also contribute valuable knowledge and local evidence to the global healthcare landscape. This first issue of this special edition includes articles covering various topics such as patient safety in dentistry, safe practices for adult intravenous push medication, regional perspectives on patient safety policies and initiatives and the impact of compassion and leadership on patient safety and quality in healthcare systems.

We, the editors, are confident that the current and future issues of BMJ Open Quality Riphah Pakistan Edition will continue to fuel advancements in healthcare quality and patient safety in Pakistan and the region.

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Publication of this article is made Open Access with funding from the Nationwide Quality of Care Network.

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  • Contributors ZA played a significant role in conceptualising the editorial theme, outlining the structure and providing critical insights. Additionally, he contributed substantially to the drafting and revising process, ensuring clarity and coherence in the final piece. KMG made substantial contributions to the editorial by offering unique perspectives and insights derived from his expertise. He also played a pivotal role in crafting specific sections of the editorial. From the initial stages of conceptualisation to the final revisions, JA provided valuable input that shaped the editorial’s narrative.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.