First steps

Patient safety remains one of the most pressing challenges in global health. Worldwide, one in ten patients experience preventable harm, ranging from medication errors and infections to misdiagnoses and delays in care.

Despite decades of progress, unsafe care continues to be a leading cause of death and disability worldwide, with the World Health Organization ranking it among the top ten global health threats.

For children, the context is even more risky. Evidence from paediatric care studies indicates that as many as one in two hospitalised children experiences an adverse event during their stay.

Small errors in paediatric care can have serious consequences that extend beyond immediate harm, potentially leading to chronic disability, longer recovery periods and repeated medical interventions, intensifying stress on families and straining healthcare resources.

Children and newborns face unique safety challenges due to their distinct physiology and developmental stages. Their care requires tailored approaches to diagnosis, treatment and monitoring.

Medication errors, infections and delays in recognising early deterioration remain significant risks in paediatric care.

As a particularly vulnerable population, children are also subject to a higher risk of epistemic injustice.

This includes testimonial injustice, when their voices or those of their families are undervalued or dismissed, and hermeneutical injustice, when they lack the language or frameworks to express their experiences.

These injustices can weaken trust and hinder safety efforts, making it essential to create systems that recognise and respect children’s perspectives.

Improving children’s healthcare safety goes beyond hospital walls. It involves creating safe environments at home, in schools and in communities – protecting their physical, emotional and developmental well-being.

At home, preventable harm may arise from unsafe storage of medications, exposure to hazardous substances and lack of proper supervision.

Beyond the household, broader social and environmental factors such as war and conflict can also contribute to increased risk.

This scenario is especially stark in low- and middle-income countries, where children face a disproportionate share of the burden of unsafe care.

Resource constraints, infrastructure gaps and inequitable access to care amplify the risks.

In 2023, children under age five in sub-Saharan Africa faced a mortality rate about 14 times higher than those in Europe and North America.

The main causes of these deaths, namely preterm birth complications, intrapartum-related events, pneumonia, diarrhoea and malaria, are largely preventable or treatable.

Beyond survival, in 2016 alone, at least 250 million children failed to reach their full developmental potential, and up to a billion were affected by violence or neglect.

These disparities highlight the urgent need for systemic change, one that embeds safety, equity and protection at every level of care, starting from birth.

Knowledge plays a crucial role in fostering a strong culture of safety. It relies on trust, openness and active collaboration between healthcare professionals, patients and families.

In paediatric care, this includes recognising parents and caregivers as essential partners and children as active participants in their own care.

Often, parents are the first to notice subtle changes, ask critical questions and ensure continuity of care.

Children, even at a young age, have voices that deserve to be heard and respected. Listening to their perspectives not only honours their rights but also helps tailor care to their individual needs and experiences.

In support of this, the World Patients Alliance partnered with Elsevier and the Elsevier Foundation to launch the Doctor Safety children’s books series, a free resource available worldwide.

This initiative transforms complex concepts of quality and safety into engaging stories and activities for children, fostering a culture of safety from an early age.

By providing families with accessible tools and information, healthcare teams can foster a culture of shared decision-making and creating spaces where both caregivers’ and children’s voices are respected.

While patient education lays the foundation for a culture of safety, we must also equip clinicians with the right knowledge tools to consistently deliver safe care.

Technologies like Elsevier’s ClinicalKey AI help clinicians navigate complexity with clarity by surfacing relevant content from evidence-based sources and providing summarised responses tailored to the case.

The most valuable contribution of such technology is delivering the right knowledge to the right person at the right time, in a way that is convenient and trustworthy.
A key aspect of using technology to drive safer clinical decision-making is technology literacy.

To support healthcare professionals navigating the new emerging generative AI technology, Elsevier created the Gen AI Academy for Health, a complementary resource to enhance AI literacy built especially for clinicians.

To truly advance safety on a global scale, we must begin from the start and ensure knowledge is shared across the patient journey.

If we fail to protect children from the beginning, we risk undermining long-term health outcomes and perpetuating global disparities.

Initiatives like the Doctor Safety books show how early education and empowerment can foster a culture of safety from childhood onward.

By listening to children’s voices, supporting families and integrating evidence into everyday practice, we can build resilient systems that prevent harm before it occurs.

Global patient safety starts with protecting our children. When we prioritise their safety from day one, we take a vital step towards a world where safe, equitable care is a reality for all.