A patient enters an operating theatre for a procedure on the right knee. The limb is marked, the scans are available and the surgical team has checked the records. Just before the operation begins, the team stops. A nurse reads out the patient’s identity, the procedure planned, the side of the body to be operated on and the type of anaesthesia. The surgeon, anaesthetist and other members of the team confirm the details. This brief pause, known as ‘timeout’, may take only a few minutes. But it is one of several layers of checks designed to prevent a potentially devastating mistake.

This exercise is an example of what Syed Mohammed Ghouse, consultant robotic and transplant surgeon, Asian Institute of Nephrology and Urology, described as the ‘Swiss cheese mechanism’, in which several layers of checks are put in place so that if one safety barrier fails, another can detect the error before it reaches the patient.

The need for such multiple safeguards is at the heart of World Patient Safety Day, observed on September 17. The World Health Organisation’s theme for 2026 is ‘Safe care for noncommunicable diseases’.

Doctors say patient safety has to be viewed much more broadly than preventing an obvious surgical or medication error. Ranga Reddy Burri, president, Infection Control Academy of India, said the understanding of patient safety has now expanded considerably: the responsibility cannot rest only with doctors and nurses. Policymakers, accreditation agencies, patients, caregivers, families, communities and even housekeeping staff have roles to play. “A hospital just having an accreditation doesn’t actually guarantee the kind of safety that is required,” Dr. Burri said, stressing the need to train all stakeholders involved in a patient’s journey.

Patient safety begins even before treatment starts, notes Dr. Burri. The availability of sophisticated diagnostic equipment has not necessarily solved the problem of ensuring an accurate diagnosis. “The diagnosis quality has actually gone down over a period of time,” he said. He attributed part of the problem to doctors moving away from basic clinical examination, including auscultation, percussion, palpation and physical examination. He described the emerging situation as ‘no touch’ healthcare, where doctors can sometimes begin looking at a computer even before adequately engaging with the patient.

Neurologist Sudhir Kumar of Apollo Hospitals, Hyderabad, also pointed to the importance of ensuring quality of medical education as the number of medical colleges and seats increases. “If we don’t ensure quality services, then it will worsen the patient’s safety because diagnosis may be missed; treatment may not be perfect,” he said.

Medication safety remains another major area of concern. Dr. Kumar said spurious and fake medicines continue to pose a patient-safety risk despite the existence of drug inspectors and regulatory checks.

Dr. Ghouse pointed to another problem of look-alike and sound-alike medicines. With a large number of pharmaceutical companies and medicines available, drugs with similar names can create opportunities for errors, particularly when medicines are handled by someone who is distracted or not sufficiently alert. He said hospitals use measures such as separate labelling and storing look-alike and sound-alike medicines away from each other, along with other quality-control measures.

Technology has reduced some types of prescription errors, but doctors say it has not eliminated them. Dr. Ghouse said typed and printed prescriptions are still not universal, especially at small clinics. Dr. Kumar said prescription errors can also occur when different doctors prescribe medicines under different brand names or when medicines from the same group are inadvertently duplicated. “For example, a patient may end up taking the same medicine twice because different brand names make it difficult to recognise that the drugs are essentially the same.”  

Some patient-safety risks are less dramatic but can still have serious consequences, particularly among older patients. Dr. Burri said falls in hospitals, including falls while patients are going to the bathroom or getting out of bed, can result in major injuries. “Hospitals need to ensure that their physical environments are designed to prevent slipping and other hazards.

Patient safety also extends beyond just their wards or rooms. Dr. Kumar pointed to hospital fires, electrical problems and other infrastructure-related hazards as areas that require greater attention. He said while the number of hospitals was increasing, some facilities are decades old, raising questions about who regularly audits their wiring and electrical connections.

For Dr. Burri, infection prevention and antimicrobial resistance (AMR) remain central to the patient-safety conversation. Unnecessary antibiotic administration, delayed diagnosis, unhygienic environments and non-adherence to infection-prevention and control guidelines can all contribute to the problem, he said.

These risks can become particularly important for patients with chronic diseases, who may require repeated interactions with healthcare facilities. Dr. Burri said patients with conditions such as chronic kidney disease, lung diseases and cancer may have vulnerabilities that make infection prevention an important component of safe care. “Healthcare workers and administrators therefore have a central role in ensuring that infection-control practices are followed,” he added.

As healthcare becomes increasingly digital, patient safety is also becoming connected to data privacy. Dr. Kumar said medical information is private, but increasing digitisation has created new risks around cybersecurity and access to medical records. He pointed to instances of hospital data breaches and leaks and said multiple categories of hospital staff may have access to digital systems for operational reasons.

Artificial intelligence is increasingly entering healthcare, but Dr. Kumar said it should remain a tool rather than become a substitute for clinical reasoning. He said there was a risk that medical students and young doctors could begin relying on AI tools too early instead of developing their own ability to analyse symptoms and arrive at differential diagnoses.

For all the technology, protocols and checklists being introduced into hospitals, the doctors point to one element that cannot be removed from the equation, the patient. Dr. Burri said patients, families, caregivers and communities must understand their own role in ensuring safety.