
One of the twelve stone displaying the Code of Hammurabi
by Stephen Campbell
Every patient, every person, deserves safe quality care. The quality and safety of care varies between countries and within countries; even within hospitals or general practices, dental practices or pharmacies. Some people will benefit from exemplary care (both clinical and inter-personal) whereas most will experience safe quality care. However, the reality is that some people / patients will receive poorer care and, in a minority of cases, unsafe, or unacceptable quality of, care.
How should this be addressed? Quality and safety improvement literature refer to various forms of incentives and rewards or penalties to reflect the safety and quality of care delivered. These can relate to financial, professional, regulatory and reputational standards and reflection of performance. It’s important to emphasise that care is provided within organisations within systems and usually as part of a team. Most unsafe and poor care is often the result of systems errors.
The idea that there will be incentives or consequences for the safety and quality of care delivered is new…is wrong. There have been some interesting approaches over the centuries. Do they have anything in common with health and social care today? Yes – they reflect the fact that it’s been recognised that care varies and patient outcomes vary and that there is an arbiter (a regulatory body or an individual) of safety and quality who will decide on the consequences for patient outcomes. Leaving aside issues of ethics, morals and legality…not to mention fairness…
Between the fifth and third centuries BC, the Hippocratic Oath required a new physician to swear, by a number of healing Gods, to uphold specific ethical standards. In essence, “First do no harm” (Latin: Primum non nocere). The “do no harm” was not new. King Hammurabi (B.C.1795-1750) was king of Babylonia who is credited with the legal Code of Hammurabi (a set of 282 laws written on twelve stones and displayed publicly for all to see). These were designed to regulate Mesopotamian society. Perhaps the most well-known is: “Eye for eye, tooth for tooth.” Delve deeper and one law stipulates that “If a doctor has opened an abscess of the eye and has cured the eye, he shall take ten shekels of silver”… however…“If a doctor has opened an abscess of the eye and has caused the loss of the eye, the doctor’s fingers shall be cut off”.
The focus on quality and safety of healthcare is mostly a post-war agenda. While it would not be appropriate to compare any existing health and social care regulatory body such as the Care Quality Commission to Mesopotamian society, it’s interesting to reflect on the fact that “regulation” of healthcare and patient outcomes is certainly not new. Thankfully, however, the current focus on “each person receives appropriate person-centred care and treatment” does not require anyone to have their fingers chopped off.
Tags: babylon, code of hammurabi, healthcare, hippocratic oath, Patient Safety, Quality and Safety, safety improvement