Patient safety in an age of multimorbidity: keeping the whole person safe

Patient safety looks different when you look after someone for years rather than for an episode of care.

That was one of the thoughts I was left reflecting on after participating as a panel member in the Asian Society for Quality in Health Care (ASQua) webinar marking World Patient Safety Day 2026.

Much of our traditional thinking about patient safety has understandably developed around episodes of healthcare: the right diagnosis, the right medicine, the right procedure, avoiding an adverse event.

All of these remain critically important.

But in general practice, I increasingly look after people who are not living with a chronic condition. They are living with multimorbidity and complexity.

A person may have diabetes, cardiovascular disease and chronic kidney disease. Another may be living with frailty, arthritis, chronic pain and cognitive decline. Many take multiple medicines and see multiple clinicians.

Then there is everything that does not fit neatly into a diagnostic code.

Loneliness. Caring responsibilities. Financial pressures. Housing. Health literacy. Culture. Family dynamics. Psychological wellbeing. The practical ability to navigate an increasingly complicated healthcare system.

These are sometimes described as additional or contextual factors.

I am not sure that is the right way to think about them.

They are part of the person’s health, and they interact with every clinical decision we make.

When good decisions collide

This complexity creates an interesting patient-safety problem.

A treatment can be clinically appropriate for one condition and still not be the right thing for the person.

A guideline recommendation may be entirely reasonable in isolation. But add another condition, another medicine, frailty, cognitive impairment, competing priorities or difficult social circumstances, and the decision becomes much less straightforward.

This leads me to a principle that I increasingly think is important:

Five individually sensible decisions do not necessarily add up to one sensible care plan.

Our healthcare system is very good at dividing complexity into manageable pieces. We create specialties, services, guidelines, pathways and funding streams around particular diseases and problems.

Patients, however, do not experience their lives in those pieces.

They experience the cumulative effect.

Perhaps safety is also about coherence

That makes me wonder whether we need to broaden our concept of patient safety.

For people living with complexity, perhaps one of the most important safety mechanisms is coherence.

Does somebody understand the whole picture?

Do the different clinicians involved know what each other is doing?

Are we clear about what matters most to the person?

Have we considered interactions between conditions and treatments?

Do we understand the psychological and social circumstances in which the care plan needs to work?

Have we considered the cumulative burden of everything we are asking the person — and often their family or carers — to do?

And does someone have permission to ask whether doing less might sometimes be safer than doing more?

These questions become increasingly important when people are living with multimorbidity, polypharmacy, frailty or cognitive impairment.

The importance of relationships

There is another dimension to safety that can be difficult to capture in traditional measures: relationships.

When you know somebody over time, you accumulate knowledge that rarely appears completely in a medical record.

You know what has been tried before. You understand what worries them. You recognise when something is subtly different. You know which recommendations they are realistically able to follow and which are unlikely to work in their circumstances.

Most importantly, you begin to understand what matters to them.

That longitudinal knowledge can itself become a safety mechanism.

It is one of the reasons I believe strong general practice and primary care are so important as healthcare becomes more complex.

Not because the GP necessarily manages everything, but because someone needs to help connect the pieces.

From disease safety to whole-person safety

Our population is ageing. Multimorbidity is increasingly common. Healthcare is becoming more specialised, technologically sophisticated and distributed across multiple providers.

Each of those developments brings enormous benefits.

But together they also create a different kind of risk: fragmentation.

The next evolution of patient safety therefore cannot only be about making individual clinical encounters safer.

We also need to ask whether the overall journey makes sense.

That requires us to think about continuity, coordination, medicines, information flow, treatment burden, social circumstances, psychological wellbeing, patient goals and the role of families and carers.

It also requires humility.

Sometimes the safest decision will be another investigation, another medicine or another intervention.

Sometimes it may be simplifying a regimen, stopping something, waiting, or agreeing that a guideline target matters less than another goal in that person’s life.

The challenge is knowing the difference.

Participating in the ASQua World Patient Safety Day webinar left me with a question that I think will become increasingly important:

Are our health systems designed to make individual diseases safer — or to keep whole people safe while living with complexity?

Those are not quite the same thing.

And I suspect much of the next chapter of patient safety lies in the difference.

I participated as a panel member in the Asian Society for Quality in Health Care (ASQua) World Patient Safety Day 2026 webinar. Further information and the webinar are available at https://www.asquaa.org/wpsd2026.