Patient safety, relating to prevention of harm during healthcare activities, is a pressing issue with substantial social and economic costs in OECD countries. It is estimated that up to 13% of healthcare spending goes towards treatment of patients harmed during care, most of which could be avoided if appropriate safety protocols and clinical guidelines were adhered to (Slawomirski and Klazinga, 2022[1]). To achieve sustainable progress towards safe care and the goals of WHO’s Global Patient Safety Action Plan 2021‑2030, a focus on promoting patient safety cultures (see section on “Safe acute care – workplace culture and patient experiences”) and improving both processes and outcomes (see section on “Patient-reported outcomes in acute care”) is vital (WHO, 2021[2]).
Surgery for hip fracture is usually performed as an urgent/unplanned procedure. Early intervention within the first 48 hours can drastically improve patient outcomes and minimise the risk of complications. Time to surgery is influenced by many factors, including hospitals’ surgical theatre capacity, staffing, flow and co‑ordination, and targeted policy and organisational interventions – such as fast-track surgery pathways implemented in several high-performing countries like the Netherlands, Norway and Sweden.
Across OECD countries, nearly four out of five (79%) patients admitted for hip fracture underwent surgery within 48 hours in 2023, ranging from 98% in Norway to 44% in Latvia (Figure 6.21). The proportion of patients whose surgery was managed in a timely manner increased substantially between 2013 and 2023 in Italy (28 p.p.), Israel (18 p.p.) and Spain (11 p.p.), while rates decreased in Lithuania, the United Kingdom, Iceland and Latvia. During this period, Italy and Israel adopted this indicator within their national quality monitoring activities, helping to highlight the importance of timely intervention within the national context.
Severe tearing of the perineum during vaginal childbirth is a drastic adverse patient safety event that often requires surgical intervention and may lead to complications such as perineal pain and incontinence. Although prevention is not always possible, appropriate labour management and high-quality obstetric care can reduce the occurrence of tears.
Figure 6.22 shows that the incidence of traumas in vaginal births without instrumental assistance ranges from 0.5% and under in Poland, Lithuania, Costa Rica and Israel to over 3% in Canada, Iceland and Denmark. Differences across countries unrelated to surgical care quality – notably rates of caesarean sections, transparency and coding practices, and use of administrative versus obstetric registry data – influence obstetric trauma rates. Accurate and transparent monitoring is essential to improve patient safety, underscoring the importance of adequately recognising, capturing and addressing the true incident rates.
While administrative data are vital for monitoring patient safety, completeness and accurate recording of medical care and outcomes are dependent on healthcare workers’ documentation when health incidents occur. A culture where workers feel they will be individually blamed for mistakes can discourage accurate reporting and inhibit individual and system performance. Although many countries are actively working to develop non-punitive, learning cultures that aim to improve patient safety by addressing system-level barriers to safe care (de Bienassis and Klazinga, 2024[3]), healthcare workers continue to give a low score to perceptions of fair response to error, with just over half of hospital care workers in OECD countries perceiving that they are treated fairly when they make mistakes and that there is a focus on learning from mistakes and supporting staff involved in errors at their workplace (Figure 6.23).
