Solving global health problems and healthcare

Do the solutions for global health lie in healthcare? A recent analysis article in the BMJ [BMJ 2014;349:g5457 doi: 10.1136/bmj.g5457] should be sobering reading for all of us. The author Jocalyn Clark reminds us to why putting all our money on healthcare to solve global health problems is doomed to failure. The article does a fine job in arguing why we need to find creative solutions that integrate healthcare into the equation. My own take on the piece is that is has interesting implications for how we train and educate doctors. I will be distributing copies of it to the clinicians that I teach, and exploring their reactions to its implications. 

Safety and quality are not necessarily the same thing!

An excellent article in BMJ Open [Mumford V, et al. BMJ Open 2014;4:e005284. doi:10.1136/bmjopen-2014-005284] reveals how safety and accreditation processes can travel in different directions. The study involved a longitudinal comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. The most interesting aspect of the study was that higher accreditation scores as reflected in hand hygiene rates appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores. Basically, smaller hospitals (with good hand hygiene scores) failed to score well on the accreditation programme due to organizational size. As the authors conclude themselves; “In this study, a focus on the accreditation results would underestimate the successful implementation of the hand hygiene policy by smaller hospitals. Conversely, just using hand hygiene results would underestimate the research and leadership investment in infection control by larger hospitals.”