Healthcare: twenty years of progress?

Healthcare has changed immeasurably over the last twenty years, as my colleagues interviewed for this anniversary edition will testify. While many healthcare professionals were once seen as subservient to the medical profession and did their bidding, now nurses and professions allied to medicine (such as physiotherapists and radiographers) conduct detailed patient assessments, prescribe drugs and work to a large extent autonomously. There has been a large movement towards specialist practice within the professions and there are now few generalists in acute care. In parallel, there has been a great change in the level of education. Nurses, in particular, are largely degree holders and many individuals go on to undertake PhDs. 

Technology has perhaps made the greatest change in healthcare, enabling far better diagnostics using magnetic resonance imaging, for example. Minimally invasive surgery has reduced the length of time a patient has to spend in hospital and developments in endoscopy have enabled treatments to be delivered directly, avoiding invasive surgery. Transplants have evolved due to drug therapies, which could not have been dreamed of twenty years ago. Interventional radiography has saved many lives. 

Patient safety science has brought much to the table and, as Professor Jane Reid reminds us, human factors learning has given us a far greater understanding of the way we behave as healthcare professionals when managing patient care and teamwork. Focus on patient safety, since the publication of To Err is Human, ¹ has been immense in all developed healthcare systems around the world. In surgery, the development and implementation of the World Health Organization Surgical Checklist has no doubt reduced the number of surgical incidents and mistakes and increased efficiency and teamwork. Awareness of patient safety science has reduced the number of patient safety incidents and healthcare infections have also fallen – although data to support this is difficult to find, as data gathering is so much better now than it was.