Keterlibatan Pasien untuk

mendorong Keselamatan Pasien

World Patient Safety Day 17 September 2023

ENGAGING PATIENTS FOR PATIENT SAFETY
dr Bambang Tutuko SpAn KIC
disampaikan tgl 13 September 2023
dr Bambang Tutuko SpAn KIC
dr Bambang Tutuko SpAn KIC
Patient and family engagement was embedded in the
Resolution WHA72.6 – “Global action on patient safety” and
the Global Patient Safety Action Plan 2021-2030 as main
strategies for moving towards eliminating avoidable harm in
health care.
Apa itu keselamatan pasien?
Keselamatan pasien adalah: “Kerangka kegiatan terorganisir
yang menciptakan budaya, proses, prosedur, perilaku,
teknologi, dan lingkungan dalam pelayanan kesehatan yang
secara konsisten dan berkelanjutan menurunkan risiko,
mengurangi terjadinya bahaya yang dapat dihindari,
memperkecil kemungkinan terjadinya kesalahan, dan
mengurangi dampak bahaya ketika itu terjadi.”
3.1 Engage patients and families as partners in safe care

Safe health care should be seen as a basic human right. As health care is predominantly a service, it
is always co-produced with the users. Achieving safe care requires that patients be informed, involved
and treated as full partners in their own care. In many parts of the world, this happens much less than
it should. Patients, families and caregivers have a keen interest in their own health and that of their
communities.
Patient safety depends on their full involvement as the users of the health care system and the people
who are most familiar with the entire patient journey. Patients and families should be involved at every
level of health care, ranging from policy-making and planning, to performance oversight, to fully
informed consent and shared decision-making at the point of care.
Patients, families and communities have essential contributions to make in patient safety.
STRATEGY 4.1:
Engage patients, families and civil society organizations in co-development of policies, plans,
strategies, programmes and guidelines to make health care safer

Actions for health care facilities and services

• Involve patient or family representatives with experience of avoidable harm in health care in
designing strategies and defining actions to reduce the likelihood of a recurrence.
• Appoint patient and family representatives to be part of the organization’s boards and committees.
• Rearrange the care processes and wherever necessary reorient them to make services patient-
centred and based on the cardinal principle of “what is important for patients and families”.
• Create patient and family advisory councils that are focused on patient safety.
• Develop procedures around the provisions of the national charter or bill, including non-
discrimination, patient autonomy, informed consent and shared decision-making, emergency
response, access to medical records and full disclosure of adverse events.
• Develop institutional standards for patient and family engagement, and develop a practice of
improvement based on patient experience.
STRATEGI 4.1:
Melibatkan pasien, keluarga dan organisasi masyarakat sipil dalam pengembangan bersama kebijakan,
rencana, strategi, program dan pedoman untuk membuat layanan kesehatan lebih aman

Tindakan untuk fasilitas dan pelayanan kesehatan

• Libatkan perwakilan pasien atau keluarga yang memiliki pengalaman mengenai bahaya yang dapat dihindari
dalam layanan kesehatan dalam merancang strategi dan menentukan tindakan untuk mengurangi
kemungkinan terulangnya kembali.
• Tunjuk perwakilan pasien dan keluarga untuk menjadi bagian dari dewan dan komite rumah sakit.
• Atur ulang proses perawatan dan bila diperlukan lakukan orientasi ulang untuk menjadikan layanan berpusat
pada pasien dan berdasarkan prinsip utama “apa yang penting bagi pasien dan keluarga”.
• Membentuk dewan penasihat pasien dan keluarga yang berfokus pada keselamatan pasien.
• Mengembangkan prosedur berdasarkan ketentuan piagam atau undang-undang nasional, termasuk non-
diskriminasi, otonomi pasien, persetujuan berdasarkan informasi dan pengambilan keputusan bersama,
tanggap darurat, akses terhadap rekam medis dan pengungkapan penuh atas KTD.
• Mengembangkan standar kelembagaan untuk keterlibatan pasien dan keluarga, dan mengembangkan
praktik perbaikan berdasarkan pengalaman pasien.
The Patients' Committee of the McGill University Health Centre
STRATEGY 4.2:
Learn from the experience of patients and families exposed to unsafe care to improve
understanding of the nature of harm and foster the development of more effective solutions

Actions for health care facilities and services

• Create a culture and organizational framework whereby the encounters and experiences of patients
and families with avoidable harm, told by themselves, are an integral part of all patient safety work
within the organization’s services.
• Include a patient and family experience, told by themselves, as a regular agenda item on the
organization’s main board meeting in order to give health care leaders a deep insight into the
realities of the impact of unsafe care.
• Create patient safety reporting mechanisms that encourage patients and families to report and, by
collecting, collating and analysing patient-reported experiences and outcomes of unsafe care,
demonstrate actions for learning and improvement.
STRATEGI 4.2:
Belajar dari pengalaman pasien dan keluarga yang terpapar pada perawatan yang tidak aman untuk
meningkatkan pemahaman tentang sifat bahaya dan mendorong pengembangan solusi yang lebih efektif

Tindakan untuk fasilitas dan pelayanan kesehatan

• Ciptakan budaya dan kerangka organisasi dimana pertemuan dan pengalaman pasien dan keluarga dengan
bahaya yang dapat dihindari, yang diceritakan oleh mereka sendiri, merupakan bagian integral dari seluruh
upaya keselamatan pasien dalam layanan rumah sakit.
• Sertakan pengalaman pasien dan keluarga, yang diceritakan sendiri, sebagai agenda rutin dalam rapat dewan
utama rumah sakit untuk memberikan wawasan mendalam kepada para pemimpin layanan kesehatan
mengenai realitas dampak perawatan yang tidak aman.
• Menciptakan mekanisme pelaporan keselamatan pasien yang mendorong pasien dan keluarga untuk
melaporkan dan, dengan mengumpulkan, menyusun dan menganalisis pengalaman dan hasil perawatan
yang tidak aman yang dilaporkan pasien, memperlihatkan tindakan untuk pembelajaran dan perbaikan.
STRATEGY 4.3:
Build the capacity of patient advocates and champions in patient safety

Actions for health care facilities and services

• Conduct a wide-ranging review to assess the involvement of patients in the improvement of safety
in health care within the organization.
• Institute measures to fully engage with patients and families to enhance their opportunities to
contribute to processes to improve patient safety.
• Develop a strategy for involving patient safety advocates and champions as educators.
STRATEGI 4.3:
Membangun kapasitas penasehat pasien dan champion keselamatan pasien

Tindakan untuk fasilitas dan pelayanan kesehatan

• Melakukan tinjauan luas untuk menilai keterlibatan pasien dalam peningkatan keselamatan layanan
kesehatan di rumah sakit.
• Melembagakan langkah-langkah untuk sepenuhnya melibatkan pasien dan keluarga guna meningkatkan
peluang mereka berkontribusi pada proses untuk meningkatkan keselamatan pasien.
• Kembangkan strategi untuk menyertakan penasehat pasien dan champion keselamatan pasien sebagai
pendidik.
STRATEGY 4.4:
Establish the principle and practice of openness and transparency throughout health care,
including through patient safety incident disclosure to patients and families

Actions for health care facilities and services

• Develop institutional policies for robust informed consent, for patient access to their medical
records, and for emergency escalation systems that can be triggered by patients and families.
• Develop and implement disclosure policies and procedures to inform patients and families of patient
safety incidents that caused (or could have caused) inadvertent harm.
• Ensure that patients, families and health workers are given ongoing psychological and other support
in the aftermath of a serious patient safety incident.
STRATEGI 4.4:
Menetapkan prinsip dan praktik keterbukaan dan transparansi di seluruh layanan kesehatan,
termasuk melalui pengungkapan insiden keselamatan pasien kepada pasien dan keluarga

Tindakan untuk fasilitas dan pelayanan kesehatan

• Mengembangkan kebijakan kelembagaan untuk persetujuan berdasarkan informasi (informed consent) yang
kuat, untuk akses pasien terhadap rekam medis mereka, dan untuk sistem eskalasi darurat yang dapat dipicu
oleh pasien dan keluarganya.
• Mengembangkan dan menerapkan kebijakan dan prosedur pengungkapan / disclosure untuk memberi tahu
pasien dan keluarga tentang insiden keselamatan pasien yang menyebabkan (atau dapat menyebabkan)
kerugian yang tidak disengaja.
• Pastikan pasien, keluarga dan petugas kesehatan diberikan dukungan psikologis dan dukungan lainnya
setelah terjadinya insiden keselamatan pasien yang serius.
STRATEGY 4.5:
Provide information and education to patients and families for their involvement in self-care
and empower them for shared decision-making

Actions for health care facilities and services

• Integrate patient and family engagement into the health care professionals curriculum, and develop
standardized patient and family engagement competencies.
• Educate patients and families about their health and health care, support patients in managing their
own health, and train families to deliver care, especially in responding to patients’ needs in a home
care environment.
• Develop patient information materials on clinical procedures, including safety risks, to empower
patients when seeking information from health care professionals.
• Implement communication mechanisms that help clinicians understand patient perspectives and
concerns.
• Structure care processes to support information sharing, care planning, self- management and
shared decision-making, and implement patient-centred tools for patients and clinicians to support
shared decision-making.
STRATEGI 4.5:
Memberikan informasi dan pendidikan kepada pasien dan keluarga atas keterlibatan mereka
dalam perawatan diri dan memberdayakan mereka untuk pengambilan keputusan bersama

Tindakan untuk fasilitas dan pelayanan kesehatan

• Integrasikan keterlibatan pasien dan keluarga ke dalam kurikulum profesional layanan kesehatan, dan
kembangkan kompetensi keterlibatan pasien dan keluarga yang terstandarisasi.
• Mendidik pasien dan keluarga tentang kesehatan dan perawatan kesehatan mereka, mendukung pasien
dalam mengelola kesehatan mereka sendiri, dan melatih keluarga untuk memberikan perawatan, terutama
dalam menanggapi kebutuhan pasien di lingkungan perawatan di rumah.
• Mengembangkan materi informasi pasien mengenai prosedur klinis, termasuk risiko keselamatan, untuk
memberdayakan pasien ketika mencari informasi dari profesional layanan kesehatan.
• Menerapkan mekanisme komunikasi yang membantu dokter memahami perspektif dan kekhawatiran
pasien.
• Menyusun proses perawatan untuk mendukung pertukaran informasi, perencanaan perawatan, manajemen
mandiri dan pengambilan keputusan bersama, serta menerapkan sarana yang berpusat pada pasien, bagi
pasien dan dokter untuk mendukung pengambilan keputusan bersama.
Background: Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between
patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-
making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to
patient engagement in shared decision-making (SDM) in Asia.
Methods: In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We
also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the
extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation.
Results: There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of
informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of
accurate and accessible health information for patients. In addition, peer support groups and ‘expert patient’ programmes were also lacking.
Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan.
Conclusion: In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area,
including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on
how SDM can be effectively implemented in Malaysia.
An overview of patient involvement in healthcare
decision-making: a situational analysis of the Malaysian
context
Results & Discussion:
The Malaysian Medical Council published a
guideline on duties of a doctor in 2001.
The guideline states that the relationship
between a doctor and a patient should be
“collaborative” and they should be in a
“partnership”. It reaffirms the importance
of the doctor–patient relationship
The doctor is also required to “give
relevant options when discussing
treatment, and the limitations and possible
complications”. These recommendations
concur with the principle of SDM, where
information is exchanged and decisions are
made based on a shared understanding
and agreement between the two parties.
This study identified the gap in the
research, practice, policies and laws related
to SDM in Malaysia.
The findings from the limited research
studies on SDM revealed a low health
literacy rate among patients, which may be
attributed to, or compounded by,
inadequate health information.
Gregório M, et al. BMJ Open 2021;11:e048488. doi:10.1136/bmjopen-2020-048488

Objective To assess patients’ preferred roles in healthcare-related decision-making in a representative sample of the Portuguese population.
Outcomes The primary outcome was patients’ preferred role for each vignette of the problem-solving decision-making scale.
Sociodemographic factors associated with the preferred roles were the secondary outcomes.
Results 599 participants (20–99 years, 53.8% women) were interviewed. Three vignettes of the Problem-Solving Decision-Making scale were
compared: morbidity, mortality and quality of life. Most patients preferred a passive role for both the problem-solving and decision- making
components of the scale, particularly for the mortality vignette (66.1% in the analysis of the three vignettes), although comparatively more
opted to share decision in the decision-making component. For the quality of life vignette, a higher percentage of patients wanted a shared
role (44.3%) than with the other two vignettes.
In the problem-solving component, preferences were significantly associated with area of residence (p<0.001) and educational level (p=0.013),
while in the decision- making, component preferences were associated with age (p=0.020), educational level (p=0.015) and profession
(p<0.001).
Conclusions In this representative sample of the Portuguese mainland population, most patients preferred a practitioner-controlling role for
both the problem-solving and decision-making components. In a life-threatening situation, patients were more willing to let the doctor decide.
In contrast, in a less serious situation, there is a greater willingness to participate in decision-making.
We have found that shared decision-making is more acceptable to better-educated patients in the problem- solving component and to people
who are younger, higher educated and employed, in the decision-making component.
 World Patient Safety Day 2023
17 September 2023

the theme
“Engaging patients for patient safety”
the slogan
“Elevate the voice of patients!”
 “Elevate the voice of patients!”

World Patient Safety Day 2023 will be observed on 17 September under

the theme "Engaging patients for patient safety", in recognition of the
crucial role patients, families and caregivers play in the safety of health
care.
Objectives of World Patient Safety Day 2023
1.Raise global awareness of the need for active engagement of patients and their
families and caregivers in all settings and at all levels of health care to improve
patient safety.
2.Engage policy-makers, health care leaders, health and care workers, patients’
organizations, civil society and other stakeholders in efforts to engage patients
and families in the policies and practices for safe health care.
3.Empower patients and families to be actively involved in their own health care
and in the improvement of safety of health care.
4.Advocate urgent action on patient and family engagement, aligned with the
Global Patient Safety Action Plan 2021–2030, to be taken by all partners.
Tujuan Memperingati Hari Keselamatan Pasien Sedunia 2023
1.Angkat kesadaran global akan perlunya keterlibatan aktif pasien dan keluarga serta
pemberi layanan mereka di semua rangkaian dan di semua tingkat layanan kesehatan
untuk meningkatkan keselamatan pasien.
2.Libatkan para pembuat kebijakan, pimpinan layanan kesehatan, petugas kesehatan dan
perawatan, organisasi pasien, masyarakat sipil, dan pemangku kepentingan lainnya dalam
upaya melibatkan pasien dan keluarga dalam kebijakan dan praktik layanan kesehatan
yang aman.
3.Berdayakan pasien dan keluarga untuk terlibat aktif dalam layanan kesehatan mereka
sendiri dan dalam peningkatan keselamatan layanan kesehatan.
4.Dukung tindakan mendesak terhadap keterlibatan pasien dan keluarga, selaras dengan
Rencana Aksi Keselamatan Pasien Global 2021–2030, yang harus dilakukan oleh semua
mitra.
The global campaign for World Patient Safety Day 2023 will propose a wide
range of activities for all stakeholders on and around 17 September,
including:
• national campaigns,
• policy forums,
• advocacy and technical events,
• capacity-building initiatives and,
• as in previous years, lighting up iconic monuments, landmarks and public
places in the colour orange (the signature mark of the campaign).
Recognizing also that improving and ensuring patient safety calls for
addressing the gaps in knowledge, policy, design, delivery and
communication at all levels,
1. ENDORSES the establishment of World Patient Safety Day, to be
marked annually on 17 September in order to increase public
awareness and engagement, enhance global understanding, and
work towards global solidarity and action by Member States to
promote patient safety;
2. URGES Member States:
2. URGES Member States:
(1) to recognize patient safety as a health priority in health sector policies and programmes, making it an
essential component for strengthening health care systems in order to achieve universal health coverage;
(2) to assess and measure the nature and magnitude of the problem of patient safety including risks, errors,
adverse events and patient harm at all levels of health service delivery including through reporting, learning
and feedback systems that incorporate the perspectives of patients and their families, and to take preventive
action and implement systematic measures to reduce risks to all individuals;
(3) to develop and implement national policies, legislation, strategies, guidance and tools, and deploy
adequate resources, in order to strengthen the safety of all health services, as appropriate;
(12) to put in place systems for the engagement and empowerment of patients’ families and communities
(especially those who have been affected by adverse events) in the delivery of safer health care, including
capacity-building initiatives, networks and associations, and to work with them and civil society, to use their
experience of safe and unsafe care positively in order to build safety and harm-minimization strategies, as well
as compensation mechanisms and schemes, into all aspects of the provision of health care, as appropriate;
2. MENDESAK negara-negara Anggota:
(1) mengakui keselamatan pasien sebagai prioritas kesehatan dalam kebijakan dan program sektor kesehatan,
menjadikannya komponen penting untuk memperkuat sistem layanan kesehatan guna mencapai cakupan
kesehatan universal;
(2) untuk menilai dan mengukur sifat dan besarnya masalah keselamatan pasien termasuk risiko, kesalahan,
kejadian buruk dan kerugian pasien di semua tingkat pemberian layanan kesehatan termasuk melalui sistem
pelaporan, pembelajaran dan umpan balik yang menggabungkan perspektif pasien dan pasien. keluarga, dan
untuk mengambil tindakan pencegahan dan menerapkan langkah-langkah sistematis untuk mengurangi risiko
bagi semua individu;
(3) untuk mengembangkan dan melaksanakan kebijakan nasional, perundang-undangan, strategi, panduan dan
alat, serta mengerahkan sumber daya yang memadai, untuk memperkuat keselamatan semua layanan
kesehatan, sebagaimana mestinya;
(12) menerapkan sistem yang melibatkan dan memberdayakan keluarga pasien dan komunitas (terutama
mereka yang terkena dampak buruk) dalam memberikan layanan kesehatan yang lebih aman, termasuk inisiatif
peningkatan kapasitas, jaringan dan asosiasi, dan untuk bekerja sama dengan mereka dan masyarakat sipil,
untuk menggunakan pengalaman mereka mengenai layanan yang aman dan tidak aman secara positif untuk
membangun strategi keselamatan dan minimalisasi dampak buruk, serta mekanisme dan skema kompensasi,
ke dalam semua aspek penyediaan layanan kesehatan, jika diperlukan;
Safe health care is a fundamental
right of all patients, everywhere,
every time. And yet, patient harm
due to unsafe care is one of the
leading causes of death and
disability worldwide, with millions
of patients harmed every year.
Pelayanan kesehatan yang aman
adalah hak dasar semua pasien, di
mana pun, kapan pun. Namun,
kerugian pasien akibat perawatan
yang tidak aman adalah salah
satu penyebab utama kematian
dan kecacatan di seluruh dunia,
dengan jutaan pasien dirugikan
setiap tahun.
Patient and family engagement is a
key strategy to developing safer
health systems. Safe health care
depends on the full involvement of
patients and families as the users of
the health care system, and it requires
a shift from care designed for patients
to care designed with patients.

Keterlibatan pasien dan keluarga

adalah strategi kunci untuk
mengembangkan sistem kesehatan
yang lebih aman. Perawatan kesehatan
yang aman bergantung pada
keterlibatan penuh pasien dan keluarga
sebagai pengguna sistem perawatan
kesehatan, dan memerlukan
pergeseran dari perawatan yang
dirancang untuk pasien menjadi
perawatan yang dirancang dengan
pasien.
Patients and families should be involved at
every level of health care, from fully
informed consent and shared decision-
making at the point of care, to policy-
making and planning.

Pasien dan keluarga harus dilibatkan di

setiap tingkat perawatan kesehatan, mulai
dari persetujuan yang diinformasikan
sepenuhnya dan pengambilan keputusan
bersama di titik perawatan, hingga
pembuatan kebijakan dan perencanaan.
No one should be harmed in health care. We
must elevate the voice of patients, and we
must listen and learn. Everybody has a role to
play: policy-makers, health care leaders,
health and care workers, patients and their
families, patient advocates and civil society.

Tidak seorang pun boleh dirugikan dalam

pelayanan kesehatan. Kita harus
mengutamakan suara pasien, dan kita harus
mendengarkan dan belajar. Setiap orang
memiliki peran masing2: pembuat kebijakan,
pimpinan layanan kesehatan, pekerja
kesehatan dan perawatan, pasien dan
keluarganya, penasehat pasien, dan
masyarakat sipil.
 World Patient Safety Day 2023 will be observed on 17 September under the theme “Engaging patients for
patient safety”, in recognition of the crucial role patients, families and caregivers play in the safety of health
 TERIMA KASIH
Dr Bambang Tutuko SpAn KIC
0816824109
bambang.tutuko@yahoo.co.id