African Partnerships for Patient Safety (APPS): Improvement Framework

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Imogen Joseph
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1 African Partnerships for Patient Safety (APPS): Improvement Framework Dr. Shams Syed Webinar 2 of 6 APPS Webinar Series November 7, 2013

Review of Webinar 1 1. Explored why patient safety is critical to health systems. 2. Described the genesis & development of WHO African Partnerships for Patient Safety. 3.

2 Review of Webinar 1 1. Explored why patient safety is critical to health systems. 2. Described the genesis & development of WHO African Partnerships for Patient Safety. 3. Provided an overview of how a partnership based approach can be used to improve patient safety. 4. Defined clear mechanisms for engagement with the programme, specifically through registration.

3 Webinar 2 Objectives 1. Describe the APPS Improvement Framework. 2. Explain the APPS 6-step process for partnership planning and implementation. 3. Define key tools and resources that can be used in each of the 6 steps. 4. Explain how to conduct a hospital patient safety situational analysis.

4 The APPS Framework

5 African Partnerships for Patient Safety The Model Hospital Hospital Objective 1: PARTNERSHIP STRENGTH Objective 2: HOSPITAL PATIENT SAFETY IMPROVEMENTS (12 Action Areas) Objective 3: NATIONAL PATIENT SAFETY SPREAD (Horizontal; Vertical; Spontaneous)

6 Objective 2: Improvement 12 Patient Safety Action Areas 1. Patient safety and health services and systems development 2. National patient safety policy 3. Knowledge and learning in patient safety 4. Patient safety awareness raising 5. Healthcareassociated infections 6. Health-care worker protection 7. Health-care waste management 8. Safe surgical care 9. Medication safety 10. Patient safety partnerships 11.Patient safety funding 12. Patient safety surveillance and research

12 Patient Safety Action Areas 1. Patient safety and health services and systems development 2. National patient safety policy 3. Knowledge and learning in patient safety 4.

7 12 Patient Safety Action Areas 1. Patient safety and health services and systems development 2. National patient safety policy 3. Knowledge and learning in patient safety 4. Patient safety awareness raising 5. Healthcareassociated infections 6. Health-care worker protection 7. Health-care waste management 8. Safe surgical care 9. Medication safety 10. Patient safety partnerships 11.Patient safety funding 12. Patient safety surveillance and research

8 The Improvement Continuum and APPS

9 Patient Safety Improvement: Emerging Learning from APPS Implementation Learning Area Simplicity vs. Complexity Patient Safety Teams Action Areas Systematic Process Measurement Patient Safety vs. Systems Knowledge and Learning Basic Infrastructure Learning Point Patient safety interventions need to be simplified as far as possible. Effective sustainable implementation requires front-line African realities to shape interventions, while keeping to evidence based practices this is a difficult balance. Early formation of a patient safety team is critical on either arm of the partnership to drive change. With time, specific teams need to be formed for specific patient safety action areas. The number of patient safety action areas tackled in the initial phase should be focused it is more important to have fewer action areas but more focused action. The 6-step patient safety improvement cycle outlined by APPS should form the basis of patient safety improvement. The 6-step cycle should be communicated widely within the hospital to enhance understanding of the importance of step-wise incremental change. It is critical to measure progress over time. Overall patient safety status can be periodically assessed through repeat patient safety situational analysis. More granular information on the status of specific patient safety areas can be gained through periodic audits. Patient safety cannot be seen in isolation of quality improvement or improving the entire health facility. Patient safety should be communicated to audiences as a tangible entry point to improve the health facility and the system that it is a part of. Patient safety interventions need to be implemented within an environment that is simultaneously focused on patient safety knowledge and learning. An intervention can be perceived as disjointed unless health professionals understand the nature of patient safety as a whole. Attention is required to basic infrastructure issues at the same time as patient safety interventions. Partnership working can form a channel for action in relation to basic equipment necessary for patient safety advancement.

10 APPS 6-Step Process & Key Tools/Resources

11 A simple 6-step process

12 APPS 6-step process: Supported by co-developed tools & resources

13 Helping you get started For new and existing hospital-to-hospital partnerships Presents a step by step framework for action For each of the six steps: - Main activities - Outputs or deliverables - Core tools & resources - Additional available tools

14 "If I had eight hours to chop down a tree, I'd spend six sharpening my axe." - Abraham Lincoln

15 Step 1: Partnership Development

16 Step 1: Main Activities 1. Secure management & leadership agreement. 2. Identify a patient safety lead & deputy. 3. Negotiate with managers to secure protected time. 4. Establish a patient safety committee. 5. Join APPS network register! 6. Identify an evaluation lead. 7. Develop/refine written statement of understanding across the partnership. 8. Download APPS resources from WHO website. 9. Work through the APPS webinars. 10. Establish regular partnership communication schedule.

17 Step 1: Outputs or deliverables 1. Exchange of letters as required. 2. A lead & deputy trained in the APPS approach using APPS webinar series. 3. Written statement of understanding between partnership.

Step 1: Core Resource APPS Partnership Definition "Partnership can be defined as a collaborative relationship between two or more parties based on trust,

18 Step 1: Core Resource APPS Partnership Definition "Partnership can be defined as a collaborative relationship between two or more parties based on trust, equality, and mutual understanding for the achievement of a specified goal. Partnerships involve risks as well as benefits, making shared accountability critical."

19 Step 1: Additional Resource Principles of Partnership Shared vision & joint planning Ownership Relationships Communication Ways of working

20 Step 2: Needs Assessment

21 Patient Safety Situational Analysis A structured tool for collecting baseline assessment information Long and a short version Identify gaps/areas of focus via Short Form Use Long Form for more detailed information on key patient safety areas

22 Step 3: Gap Analysis

24 Step 3: Core Resource Improving Patient Safety: First Steps Lists the critical considerations for patient safety improvers at the start of their journey in each of the 12 Action Areas Some of these may already have been addressed if so, consider how to strengthen and sustain.

Example "First Steps": Action Area 8: Safe Surgical Care Lobby for national policy, develop local policies Work with WHO experts and national focal points to lobby for

Leaders Identify and develop leaders for safe surgery.

25 Example "First Steps": Action Area 8: Safe Surgical Care Lobby for national policy, develop local policies Work with WHO experts and national focal points to lobby for national policy on safe surgery, develop hospital policies on safe surgery focused on introducing or strengthening the use of the WHO Safe Surgical Checklist Develop Leaders Identify and develop leaders for safe surgery. Improve the system for record keeping Consider how to establish or strengthen mechanisms to record hospital deaths or complications following surgery Focus on measurement Consider how to establish hospital data capture mechanisms that measure key parameters of safe surgery in hospital operating rooms

26 Step 4: Acting Planning

28 Step 4: Core Resource

29 Step 5: Action

31 Step 5: Core Resource APPS Resource Map Provides information on patient safety resources available around the world. Provides all the information in one place. Shows how to access the resource, also sharing case studies of use.

32 What do we mean by a Resource? Guidance Policies Publications Templates Toolkits

Level 1 Level 2 Find more detail on the purpose of the resource; Read about the likely challenges and benefits associated with the

33 Navigating the Resource Map Find your priority action area; Consider the column headings and find the resource related to the column headings of interest; Follow the page reference to level 2 and 3. Level 1 Level 2 Find more detail on the purpose of the resource; Read about the likely challenges and benefits associated with the resource; Learn how to get hold of a copy of the resource. Read about where and how the resource has been used in the field. Find contact details of institutions/organizations willing to share their insights. Level 3

34 Step 6: Evaluation & Review

Step 6: Core Resource APPS Evaluation Handbook Patient safety improvement tracked through situational analysis and hand hygiene self assessment.

36 Step 6: Core Resource APPS Evaluation Handbook Patient safety improvement tracked through situational analysis and hand hygiene self assessment. Domains of partnership strength (& further sub-components) are examined through the APPS partnership evaluation process. Spread of improvement tracked.

37 Hospital patient safety situational analysis

38 Situational Analysis A structured tool for collecting baseline assessment information Yes/No approach Long and a short version Identify gaps/areas of focus via Short Form Use Long Form for more detailed information on key patient safety areas

39 Situational Analysis Tool Structure Part 1: addresses key steps in information collection. Part 2: related to general hospital information. Part 3: consists of a series of questions based around the 12 key patient safety action areas.

40 Part 1: Information Collection Key Steps 1. Identify key individuals that have an interest in patient safety - Champion - Information gatherer 2. Form a core patient safety team 3. Arrange sensitisation meetings 4. Secure management support for undertaking situational analysis 5. Be efficient with time are previous assessments available?

41 Part 2: Hospital Information General information Workforce snapshot Infrastructure

42 Part 3: 12 Patient Safety Action Areas Questions Short Form: - Yes/No - Minimum 7, maximum 10 questions in each action area - No qualitative data captured Long Form: - Space for additional information for questions - Allows hospital teams to drill deeper - Aids in action planning in specific areas

43 Example Short Form Action Area 1: Patient Safety & Health Services/Systems Development

44 Example Short Form Action Area 3: Knowledge & Learning in Patient Safety

45 Example Short Form Action Area 5: Health care associated infection

46 Example Short Form Action Area 10: Patients and Communities

47 And the Long Form

48 Final Reflections

50 Summary Points The APPS Framework can be utilized for patient safety improvement through utilizing hospital-tohospital partnerships. Systematic use of the APPS 6-step process for hospital partnership implementation (with all available tools) can aid partnership work. A hospital patient safety situational analysis can play a catalytic role in improvement efforts. We need to continue to learn from active patient safety partnerships registrations welcome!

52 Please visit our website to find out more about the programme and access our resources THANK YOU

African Partnerships for Patient Safety. Evaluation Handbook April 2012

African Partnerships for Patient Safety Evaluation Handbook April 2012 WHO/IER/PSP/2012.8 World Health Organization 2012 The designations employed and the presentation of the material in this publication