FIRST INTERIM REPORT 01/10/ /09/2011

Transcription

1 Improving Patient Safety of hospital care through Day Surgery DAYSAFE is co-funded by the European Commission under the Programme of the Community Action in the field of Public Health FIRST INTERIM REPORT 01/10/ /09/2011 DAYSAFE Deliverable N 10 - November 2011

2 Co-ordinator: Agenzia Nazionale per i Servizi Sanitari Regionali AGE.NA.S Rome, Italy Co-beneficiaries: Belgium Institut National d Assurance Maladie * National Institute for Health and Disability Insurance - NIHDI Belgium AZ Sint-Augustinus vzw - GZA Denmark Danske Regioner * Association of Danish Regions - ADR France Haute Autorité de Santé - HAS France Agence Nationale d Appui à la Performance - ANAP Hungary Europ-Med KFT - EUROPMED Italy Agenzia Regionale Socio Sanitaria del Veneto - ARSS Veneto Italy Azienda Ospedaliera di Padova - AOP Norway Martina Hansens Hospital - MHH Portugal Administração Regional de Saude do Norte, IP - ARSN Portugal Centro Hospitalar Do Porto - CHP Romania County Emergency Hospital Timisoara - SCJUT Spain Catalan Agency for Health Information, Assessment and Quality - CAHIAQ DAYSAFE Deliverable N 10 - November 2011

3 LIST OF CONTENTS PROJECT FACT SHEET Pag. 1 1 EXECUTIVE SUMMARY Pag Background Objectives Methods and Means Expected Outcome Organisation of the project Activities undertaken in the period covered in the interim report 5 2 PROJECT SPECIFICATIONS Pag General Objective of the project Specific Objectives of the project Overview of activities for the period covered in the interim report 8 3 TECHNICAL IMPLEMENTATION OF THE PROJECT Pag Activities related to horizontal work packages 11 WP1: Coordination of the project 11 WP2: Dissemination of the results 15 WP3: Evaluation of the project Activities related to project objectives (core Work Packages) 19 WP4: Assessment of DS current organization and performance 19 WP5: Identification of DS best practices and standards 23 APPENDICES Appendix I Kick-off Meeting - Venice, Italy - October 22 nd, 2010 Appendix II Coordination Meeting in AGENAS - Rome, Italy - October 28 nd, 2010 Appendix III Coordination Meeting in AGENAS - Rome, Italy - February 23 rd, 2011 Appendix IV Coordination Meeting in ANAP - Paris, France - November 29 th, 2010 Appendix V Coordination Meeting in HAS - Paris, France - February 11 th, 2011 Appendix VI Journées Internationales de la qualité hospitalière et en santé - Paris, France - November 30 th, 2010 Appendix VII Hopital demain - Venice, Italy December 3 rd, 2010 Appendix VIII 9 th International Congress on Ambulatory Surgery - Copenhagen, Denmark May 9 th, 2011 Appendix IX DaySafe website Appendix X IAAS Website and Newsletter Appendix XI Gant table Appendix XII WP4 Final report Deliverable n 1 DAYSAFE Deliverable N 10 - November 2011

4 PROJECT FACT SHEET Grant Agreement number: Proposal title: Improving patient safety of hospital care through Day Surgery Acronym: DAYSAFE Starting date: 01/10/2010 Duration of the project: 36 months Reporting period: 01/10/ /09/2011 Main partner: AGE.NA.S - Agenzia Nazionale per i Servizi Sanitari Regionali, Italy Number of associated partners: 13 1) National Institute for Health and Disability Insurance - NIHDI Belgium 2) AZ Sint-Augustinus vzw - GZA - Belgium 3) Association of Danish Regions - ADR - Denmark 4) Haute Autorité de Santé - HAS - France 5) Europ-Med KFT - EUROPMED - Hungary 6) Agenzia Regionale Socio Sanitaria del Veneto - ARSS Veneto - Italy 7) Azienda Ospedaliera di Padova - AOP - Italy 8) Administracão Regional de Saúde do Norte, IP - ARSN Portugal 9) Centro Hospitalar Do Porto CHP, EPE Portugal 10) County Emergency Hospital Timisoara - SCJUT - Romania 11) Catalan Agency for Health Information, Assessment and Quality - CAHIAQ Spain 12) Orebro University Hospital - USO - Sweden LEAVING BENEFICIARY: EFFECTIVE DATE OF WITHDRAWAL OCTOBER 10 th, ) Agence Nationale d Appui à la Performance - ANAP - France NEW BENEFICIARY: WITH EFFECT FROM OCTOBER 10 th, ) Martina Hansens Hospital - MHH - Norway Total amount of the project: EC Co-funding: First pre-financing payment: Second pre-financing request: ,00 Euros ,00 Euros ,00 Euros ,00 Euros DAYSAFE Deliverable N 10 - November

5 1 EXECUTIVE SUMMARY 1.1 BACKGROUND Surgical procedures represent an essential component of health services delivery. The practice of surgery has been transformed by technological innovations, and less invasive surgical and anaesthesiological techniques which allow procedures of shorter duration and a quicker recovery. An aging population has strong implications for the increasing demand of some of the most common surgical procedures such as cataract, varicose veins, hernia repairs and gallstones. A very convincing evidence exists that Day Surgery (DS) can lead to better safety, in particular a much lower incidence of hospital infections (Healthcare Commission, Acute Hospital Portfolio review, Day Surgery, July Audit General for Scotland, Day Surgery in Scotland, September Wales Audit Office, Making better use of NHS day surgery in Wales, September 2006). DS also results in major progress of surgical services technical efficiency and higher satisfaction of patients and families, shortening their separation, diminishing anxiety and allowing recovery in a familiar setting (Policy Brief,DS Making it happen,2007). Both within and among MSs nations, variability in DS practices and standards is both considerable and inadequately known. The results of a recent survey conducted by the International Association for Ambulatory Surgery (IAAS) in 19 countries shows that the percentage of a simple and easy surgical procedure such as hernia repairs performed as day cases by MSs health services varies between 6 and 73%, whereas it is almost 90% in the USA. Similar variability is apparent for other common procedures like cataract removals (Toftgaard C, 2006-DS Development and practice, London). Despite several advantages brought about by DS, in Europe there is no comprehensive investigation of DS strategies, practices and standards and the efforts to promote safety through DS in MSs have been limited. In summary, DS in Europe too often represents a missed opportunity for the reorganization of surgical services (NHS Modernisation Agency 2004). This means that, at present, most European citizens are denied a high safety, high quality and cost-effective approach which is the best option for about 80% of elective surgical operations. 1.2 OBJECTIVES The general objective of the project is to improve patient safety and quality of hospital care through the promotion of DS best practices and standards. The project aims to improve safety of hospital care for the about thirty five millions European citizens undergoing surgical treatment every year in EU through easier access to safer and higher quality surgical services of shorter duration without night stay. The specific objectives of the project include the following ones: 1 to assess DS current organization and performance 2 to identify DS best practices and standards 3 to promote DS best practices and standards 4 to develop measurement systems increasing compliance by DS patients and conformity by DS managers and providers DAYSAFE Deliverable N 10 - November

6 1.3 METHODS AND MEANS The assessment of DS organization and performance (Objective 1) will be conducted adopting several methods. First, semi-structured in depth telephone and face-to-face interviews with key informants, i.e. DS managers and providers from participating MSs. Some interviews will be carried out through focus groups. Secondly, information will be collected through questionnaires submitted to a larger sample of informants. Thirdly, a set of indicators compiled from routine data will illuminate DS safety and quality issues. The combination of quantitative and qualitative methods will take full advantage of sources of information. Data will play a critical role in the analysis of performance, preventing ideologies and interests to dominate. However, data cannot fully describe our topic in isolation from an analysis of the context in terms of political, social and ethical perspectives. Therefore, as far as DS performance is concerned, the analysis will be data driven, but also consider the broader milieu. Best practices and standards will be identified (Objective 2) through a benchmarking exercise, i.e. comparing performance across nations and local situations in order to detect top organizations, their processes and structures and find out why these distinguish themselves. The comprehensive documentation of DS best practices and standards (Objective 3) will be structured following principles and methods derived from system theory, management and clinical medicine. This approach will facilitate understanding and adoption of these instruments by providers and managers. Best practices and standards will be promoted through a one week course, open to MSs health policymakers. The teaching methods and tools will be adapted to the elearning approach. The development of measurement instruments to assess compliance by patients and conformity by staff (Objective 4) will use methods drawn from continuous quality improvement (e.g. design of checklists to determine degree of conformity) and social sciences (e.g. blueprint of a questionnaire to assess patients and families satisfaction with DS services). 1.4 EXPECTED OUTCOME The project will enhance DS which represents a crucial strategic approach toward the improvement of health services safety and quality, including patients satisfaction, together with technical efficiency and, possibly, equity. The project will make policy-makers at EU and MSs level knowledgeable about factors constraining DS performance, from operational aspects, such as faulty patient management processes and inadequately designed infrastructures, to strategic issues, like limited allocation of financial resources and poor strategic planning. Understanding of DS main issues represents a precondition for educated decisions. DS managers and providers will have available a systematic collection of DS clinical and patient management processes and standards that will assist them in programming and managing systems and units. Best practices and standards will DAYSAFE Deliverable N 10 - November

7 clarify key topics and make easier the progress toward implementation. The concept of best practice offers a way to bundle several conceptually related but independent disciplines in a way that has the potential to improve performance of health systems and thus population health. DS managers and providers will have on hand complete and easy to use checklists that will enable them to assess patients compliance with protocols and units conformity with best practices and standards. The utilization of a questionnaire about patient and family satisfaction and safety concerns will contribute to the detection of factual and perceived problems and their prompt correction. In general, an expected outcome of the project is to move forwards decisionmakers, managers and staff from lack of knowledge to awareness and thorough understanding. Education activities will contribute to the appreciation by local leaders and adaptation of best practices and standards to local situations. Such process will lead to better prepared personnel ready to accept responsibilities for the organization and delivery of DS services and to be accountable for the results. In the future, European health systems will increasingly face an ethical and political dilemma regarding how to assure sustainable and equitable access to safe and effective procedures. All the above mentioned outcomes will translate into improvements of safety and quality of care for most European citizens in need of surgical care. 1.5 ORGANISATION OF THE PROJECT The project is led by a Scientific Committee (SC) consisting of one representative for each associated partner, assisted by an Expert Team made up of 3 experts in public health, in charge of scientific and strategic corodination of core WPs. A Project Management Team (PMT), composed by the Project Coordinator, a Project Manager, a Financial Manager, a National Project Manager and a Project Leader ensures the project general coordination and financial administration. DAYSAFE monitoring and evaluation is carried out by an Assessment Group (AG) consisting of three experts members of the International Association for Ambulatory Surgery (IAAS). IAAS, which is one of the collaborating partners of the project, is a network of national scientific societies and health care professionals dedicated to the development and growth of high quality ambulatory surgery worldwide. The project is divided in the following work packages: Three horizontal WPs WP1: Coordination of the project WP2: Dissemination of the project WP3: Evaluation of the project Four Core WPs WP4: Assessment of DS current organization and performance WP5: Identification of DS best practices and standards WP6: Comprehensive documentation and promotion of DS best practices and standards WP7: Development of measurement tools to increase compliance and conformity DAYSAFE Deliverable N 10 - November

8 1.6 ACTIVITIES UNDERTAKEN IN THE PERIOD COVERED IN THE INTERIM REPORT From a technical perspective, DaySafe first year covered WP4 and, partially, WP5, due for completion by February DaySafe intends to elucidate main issues concerning ambulatory surgery, investigating DS at different levels of MSs health systems, offer relevant, practical and flexible solutions, and recommend the design and adoption of evidence-based best practices and standards identified through benchmarking. WP4 aimed at contributing to the filling of the knowledge gap concerning European DS inputs, functioning, performance and strategy. The key information which represented the focus of WP4 was to understand the differences between Countries in order to benchmark the best solutions. Following a specific review of the literature, both peer and grey, data were obtained through direct involvement of each participating Country. The investigation was structured in such a way as to obtain precise information for each of the following levels: National or Regional level; Hospital level; DS unit level. At the National or Regional level we explored the strategy of the respective Ministries of Health with relation to DS as well as resources allocation and the financial system set up for its promotion. At the hospital level we mainly investigated whether the National/Regional indications on DS were put into practice as a part of operational planning (i.e. assignment of infrastructures, equipment and staff). At the DS unit level we clarified the different ways in which the services function and are organized (i.e. single or multi-specialty DS services integrated with inpatient facilities; freestanding self-contained units separated or linked to the main hospital building). Tools utilized were: online questionnaires, face to face or telephone interviews and focus groups. The amount of information obtained through this WP is impressive. The general objective of WP4 to assess the current organization and performance of DS across Europe as a first step in the identification of DS best practices and standards (WP5) has been fully achieved. DAYSAFE Deliverable N 10 - November

9 WP5 objective is to identify DS Best practices and standards through a benchmarking exercise, i.e. comparing top organizations, their processes and structures, and finding out the reasons why these distinguish themselves from the rest. Sources of evidence include both literature search and discussion with professionals and managers. HAS, the WP leader, has carried out an extensive review of the scientific and grey literature, which represents a fundamental contribution to the project s objectives. The following step consists of interviews with key informants belonging to the International Association of Ambulatory Surgery (IAAS), national societies of ambulatory surgery and other established leaders at DS unit and system level. From the managerial viewpoint, the 3 WPs: Coordination of the project, Dissemination of the results and Evaluation of the project have established and started their activities as later described. DAYSAFE Deliverable N 10 - November

10 2 PROJECT SPECIFICATIONS 2.1 GENERAL OBJECTIVE OF THE PROJECT The general objective of the project is to improve patient safety and quality of hospital care through the promotion of DS best practices and standards. This project intends to elucidate main issues concerning ambulatory surgery, investigating DS at different levels of MSs health systems, and also offer realistic solutions, recommending evidence-based best practices and standards identified through benchmarking. This initiative aims to provide some relevant, practical and flexible answers to European health systems increasingly facing an ethical and political dilemma regarding how to assure sustainable and equitable access to safe and high quality health care. This initiative will study, review, identify and promote essential components of DS systems and units, i.e. structures, clinical and patients management processes. The project will compare, select and systematically promote best practices and standards. It will also develop measurement instruments to gauge patients compliance with protocols and DS managers and providers conformity with standard inputs and processes. 2.2 SPECIFIC OBJECTIVES OF THE PROJECT N Title Description WP 1 To assess DS current organization and Investigation of a selected sample of DS systems and 4 performance units with the aim to describe structures, processes and performance defined in terms of safety and 2 To identify DS best practices and standards 3 To promote DS best practices and standards 4 To develop measurement systems increasing compliance by DS patients and conformity by DS managers and providers quality. Identification of best practices concerning DS key clinical and patient management processes and inputs. Comprehensive documentation of best practices and standards relevant for DS care systems and units. Support to the integration of best practices and standard within MSs DS systems and units. Design of checklists to measure patient compliance with DS protocols. Design of a questionnaire to assess conformity with DS processes and inputs DAYSAFE Deliverable N 10 - November

11 2.3 OVERVIEW OF ACTIVITIES FOR THE PERIOD COVERED IN THE INTERIM REPORT (1) WP Activities/Tasks Outcomes/ Deliverables Date foreseen Date of achievement Level of achievement (measured by indicators) 1 Organization of Kick off meeting in Agenda and slides M1 M1 Almost fully achieved: all the Venice, Italy partners, apart from ANAP, France participated to the meeting. Coordination meeting in Rome, Italy - AGENAS Coordination meeting in Paris, France - ANAP Coordination meeting in Paris, France - HAS/ANAP Coordination meeting in Rome, Italy - AGENAS Setting up of the work plan Setting up of the work plan Sharing of goals and strategy of WP5 Setting up of the work plan Not scheduled and budgeted in the project No costs will be claimed Not scheduled and budgeted in the project No costs will be claimed Not scheduled and budgeted in the project No costs will be claimed Not scheduled and budgeted in the project No costs will be claimed M1 M2 Fully achieved: work plan agreed among AGENAS, the Project Management Team and the Expert Team Fully achieved: work plan agreed with ANAP M5 Fully achieved M5 Fully achieved Justification/Probl ems encountered French partner ANAP did not participate Tasks to be performed by the new beneficiary Action to be taken to overcome the problem Presentations available in the project s website. Amendment request to EACH First interim report D10 M12+2 M12+2 Fully achieved DAYSAFE Deliverable N 10 - November Grant Agreement

12 2.3 OVERVIEW OF ACTIVITIES FOR THE PERIOD COVERED IN THE INTERIM REPORT (2) WP Activities/Tasks Outcomes/ Deliverables 2 Implementation and update of the official project website and IAAS website Participation to the International Congress Journées internationals de la qualité hospitalière & en Santé JIQHS, Paris, France Participation to the International Congress Colloque international : l Hopital Demain», Venice, Italy Participation to the «9th International Congress on Ambulatory Surgery», Copenhagen, Denmark Date foreseen Date of achievement Level of achievement (measured by indicators) D7 M36 M36 Ongoing: official project website published, available to project partners and wider public. Update of the project in IAAS website and IAAS Newsletter Dissemination Dissemination Dissemination Not scheduled and budgeted in the project No costs will be claimed Not scheduled and budgeted in the project No costs will be claimed Not scheduled and budgeted in the project No costs will be claimed M2 M3 M8 Fully achieved: presentation held in Paris on November 30, Speaker: Project Leader Fully achieved: presentation held in Venice on December 3, 2010 Speakers: project leader and expert in Public Health (member of the Expert Team) Fully achieved: presentation held in the session International projects in Day Surgery held on May 9, 2011 Speakers: Guy Dargent from EAHC and Carlo Catoro, President of IAAS Justification/Probl ems encountered Promotion of project objectives, main activities and expected results to stakeholders, relevant institutions and persons interested in the project Promotion of project objectives, main activities and expected results to stakeholders, relevant institutions and persons interested in the project Promotion of project objectives, main activities and expected results to stakeholders, relevant institutions and persons interested in the project Action to be taken to overcome the problem DAYSAFE Deliverable N 10 - November Grant Agreement

13 2.3 OVERVIEW OF ACTIVITIES FOR THE PERIOD COVERED IN THE INTERIM REPORT (3) WP Activities/Tasks Outcomes/ Deliverables 3 Participation of the Assessment Interviews with Group during the Kick off meeting in participants on their Venice, Italy expectations from the project Participation of the Assessment Group during the IAAS General Assembly meeting in Copenhagen, Denmark Interviews with partners on their expectations from the project Date foreseen Not scheduled and budgeted in the project Not scheduled and budgeted in the project Date of Level of achievement achievement (measured by indicators) M1 Achieved: work plan agreed M8 Achieved: GANT diagram agreed Justification/Probl ems encountered Action to be taken to overcome the problem 4 Analysis of DS organization and performance literature Peer and Grey literature October - November 2010 Fully achieved 5 Research protocol Survey: online questionnaires face to face or telephone interviews focus groups Report on DS current organization and performance in participating Countries Review of the literature on DS best practices and standards Interviews with key informants Survey tools identified for data collection Surveys performed at National-Hospital and Day Surgery Unit levels December March 2011 April August 2011 Fully achieved. Protocol agreed among the partners Fully achieved. D1 M12+1 M14 Fully achieved. Next steps non included in the interim report period: Report on Clinical best practices D2 M17 Report on Patient management best practices D3 M17 Report on standards for key inputs D4 M17 DAYSAFE Deliverable N 10 - November Grant Agreement

14 3 TECHNICAL IMPLEMENTATION OF THE PROJECT 3.1 ACTIVITIES RELATED TO HORIZONTAL WORK PACKAGES: WP1: Coordination of the project ACTIVITIES UNDERTAKEN In this work package the following activities have been undertaken: Assuring good communication and cooperation among all participants Acting as the contact between all the participants and the EAHC Project Officer Setting up of the work plan of the project and assuring that the described objectives are attained Updating the whole partnership about the project s progress through regular contacts by s and telephone calls Organizing the kick-off meeting and additional coordination and technical meetings Fostering communication, collaboration and integration of activities through conference calls and a dedicated website with a section accessible only to participants. Drawing up of the interim report The above-mentioned activities have been undertaken thanks to the PARTNERSHIP The Project Management Team has no concerns over the partnership s performance during the first interim report period. We wish to point out that DAYSAFE partners are also active members of the International Association for Ambulatory Surgery (IAAS). As such, they had been collaborating together also before the beginning of the project. IAAS, which is one of the collaborating partners of the project, is recognized as the leading international organization promoting Ambulatory Surgery, providing education and promoting a lively debate around this issue. IAAS formally brings together the top global expertise on Day Surgery being composed of National Ambulatory Surgery Associations from twenty-three countries including European Countries, the USA and Australia. Moreover most of the partners are also involved in the DSDP project co-funded by the European Commission (Grant Agreement ) and coordinated by ARSS Veneto. Therefore their previous knowledge added to their expertise in Ambulatory Surgery has avoided any problems in establishing an efficient network. The international expert in public health has contributed to maintain cohesive research links and enhanced as a result of the collaborative work required by the project. DAYSAFE Deliverable N 10 - November

15 MANAGEMENT STRUCTURE The project has been led by a Scientific Committee (SC), consisting of one representative for each associated partner. The SC has been responsible for the day-to-day running of the project and for ensuring the smooth implementation and evolution of the project activities. The SC is also the place where potential conflicts and risks are managed and sorted out by the partnership. As far as the strategic development of the project, the project management and its dissemination are concerned, the SC is assisted by a Project Management Team (PMT), the managerial decision-making body for the project. It consists of: the Project Coordinator, the Project Manager, the Financial Manager, the National Project Manager and the project Leader. The PMT ensures the project general coordination and financial administration. It has established an effective interface with the project officer, mechanisms to make decisions affecting the project s outcome, as well as administrative and technical co-ordination of the project. 1 Project Manager in each participating country has been appointed to coordinate the project at local level. An Assessment Group (AG) has also been established. Its task is to evaluate both the scientific value of the outputs and the project s management. It consists of 3 eminent representatives of the International Association for Ambulatory Surgery (IAAS) who are not involved in any of the project activities. An Expert Team (ET) has been appointed to support the SC s activities. It consists of 1 international expert in qualitative research and 3 international experts in public health. DAYSAFE Deliverable N 10 - November

16 Internal communication The PMT and SC have been very active, through regular telephone calls and occasional face-to-face meetings. In the starting phases communication between partners and the project coordinator has been very intense. Telephone calls and additional face-to-face meetings have been necessary to ensure the correct understanding of the project tasks. Communication strategy Frequent and effective communication between partners has been essential to the success of the first phase of the project. The working language of the project is English and all partners are expected to have a reasonable competency in this language in order to ease communications between members of the partnership. Partners have used , telephone and fax to keep in regular contact with each other. In some cases, conference calls have also been arranged between partners. One kick off meeting in Venice and additional coordination meetings, not scheduled and budgeted in the project, were organized during the period this report refers to. Kick-off meeting in Venice On October22 nd 2010, DAYSAFE project was officially presented to EAHC Project Officer. All the associated beneficiaries were invited to participate to present themselves and their contribution to DAYSAFE. The project leader and the project coordinator present to all the partners the structure and the work plan of the project (Agenda of the Meeting: see Appendix I). The presentations held during the meeting are available on DAYSAFE project website: Coordination meetings in AGE.NA.S, Rome held on - October 28 th, 2010 (see Appendix II) - February 23 rd, 2011 (see Appendix III) not budgeted and scheduled in the project, were organized by the PMT to discuss: - the work plan: what at what time with whom to achieve the project objectives - the human resource planning: which type of staff will be involved for the tasks that are planned and number of working days. Coordination meeting in ANAP, France held on - November 29 th, 2010 (see Appendix IV) not budgeted and scheduled in the project, was organized by the project leader and the project coordinator to discuss with the new partner ANAP tasks to be performed. Coordination meeting in HAS, France held on - February 11 th, 2011 (see Appendix V) not budgeted and scheduled in the project, was organized by the project leader, the project coordinator and the international expert in Public Health to discuss with HAS and ANAP (WP5 Project Leaders) the work plan and the budgetary issues. DAYSAFE Deliverable N 10 - November

17 Problems encountered During the first year the partnership didn t have any problems in starting and running the project activities. This is mainly due to the fact that most of the partners are also involved in the DSDP project co-funded by the European Commission (Grant Agreement ) and coordinated by ARSS Veneto. At the very beginning of the project the Swedish partner, USO, withdrew from the partnership, being the tasks required by the project not compatible with all the activities he had to perform at his institution. How were problems resolved A new beneficiary, ANAP, was identified and a formal amendment sent to the EU Commission requiring their access to the partnership with effect from October 10 th, Activities planned for the next period In continuation to the activities performed in the first interim report, WP 1 plans the following activities for the second interim report: - To co-ordinate and manage the project s resources - To monitor the progress of the project, and to achieve its deliverables and milestones on time - To continue effective communications among partners - To update the project web site - To update members with the progress in each work package - To enable project cohesion and promote co-operation between partners - To liaise with the EAHC and to ensure that all the EAHC s requirements for reporting are met DAYSAFE Deliverable N 10 - November

18 WP2: Dissemination of the results Dissemination plan available X no yes (please attach as Annex 1) The aim of this Work Package is to inform stakeholders, relevant institutions and persons interested in the project about its objectives, main activities and expected results, as well as about its outputs and outcomes. ACTIVITIES UNDERTAKEN stakeholder analysis / target group identification During the first interim period, the project aims and its first results have been promoted among Surgeons and Day Surgery Departments through the channels of the International Association for Ambulatory Surgery - IAAS (collaborating partner of the project). In particular the Executive Committee and General Assembly meetings have been the strategic occasion to promote the first results of our project. Moreover, IAAS website and IAAS newsletter have published information about the project; Policy makers and National and Local Health Systems have been informed by means of the project s website and by each project partner in his own country through its National Association for Ambulatory Surgery. dissemination contents Main activities and intermediate results of the project have been promoted to stakeholders during the following International Congresses: Journées internationales de la qualité hospitalière et en Santé, Paris, France On November 30th, 2010 (see Appendix VI). Hopital demain, Venice, Italy On December 3 rd, 2010 (see Appendix VII). 9 th International Congress on Ambulatory Surgery, Copenhagen, Denmark On May 9 th, 2011, an international session International projects in Day Surgery has been organized in order to promote the main activities and intermediate results of the project during IAAS International Congress (see Appendix VIII). DAYSAFE Deliverable N 10 - November

19 dissemination means Different means of communication have been used. The website set to broaden the awareness of the project activities, as well as outcomes and events organized within the project, is the most efficient means of communication used for dissemination purposes. The website is reachable at the following web address (see Appendix IX). Besides the website, large visibility to the project has also been given by the International Association for Ambulatory Surgery IAAS (collaborating partner of the project) through its official website and quaterly Newsletter (see Appendix X). PROBLEMS ENCOUNTERED No problems so far. HOW WERE PROBLEMS RESOLVED n.a. ACTIVITIES PLANNED FOR THE NEXT PERIOD - To develop, co-ordinate and review appropriate dissemination strategies among the partners - To update the project website in order to share information and communicate within the partnership, and as a tool for dissemination and communication with stakeholders and the wider public - To ensure effective dissemination of the project s results to stakeholders also at European level as envisaged in the original application. DAYSAFE Deliverable N 10 - November

20 WP3: Evaluation of the project Evaluation plan available X no yes (please attach as Annex 1) An Assessment Group (AG), not involved in any of the project activities, has been appointed to evaluate both the scientific value of the outputs and the project management. During the first period covered by this interim report, evaluation has been focussed on two aspects: 1. Active participation of both associated and collaborating countries in the project activities; 2. Respect of scheduled milestones and deliverables according to the project WPs. ACTIVITIES UNDERTAKEN data collection for process evaluation At the end of the kick off meeting and on the occasion of the General Assembly meeting of our Collaboratoring partner IAAS, held in Copenhagen on May 8 th, 2011, two of the three members of the AG took the opportunity to interview DAYSAFE partners in order to measure their level of satisfaction regarding both the project management and its scientific issue. The AG is also in constant relation with the PMT to monitor the project activities progress. The GANT table shows the date of achievement of the deliverables expected for this period and it is constantly monitored by the AG to verify the respect of the due deadlines (see Appendix XI). analysis of process evaluation data The discussion group activities have given the PMT very helpful information as far as the planning of activities are concerned and if they meet their expectations. It was an open discussion where all the partners could express their doubts uncertainties. Indeed all the partners confirmed their commitment to the project activities, as previously discussed by mail with the project coordinator. Being a discussion group, data were not analysed scientifically. suggestions for improvement n.a. data collection for effect evaluation (baseline) The members of the AG have interviewed the DAYSAFE partners. analysis of effect evaluation data An Evaluation report will be produced at the end of the project (M36). DAYSAFE Deliverable N 10 - November

21 PROBLEMS ENCOUNTERED No problems so far. HOW WERE PROBLEMS RESOLVED n.a ACTIVITIES PLANNED FOR THE NEXT PERIOD - To monitor tasks achievement DAYSAFE Deliverable N 10 - November

22 3.2 ACTIVITIES RELATED TO PROJECT OBJECTIVES (CORE WORK PACKAGES): WP4 Assessment of DS current organization and performance - See Appendix XII: Deliverable 1 - The general objective of WP4 was to assess the current organization and performance of DS across Europe as a first step in the identification of DS best practices and standards (WP5). Specific objectives of WP4 were the following: to understand differences in the strategic approach and in the financial systems relevant to DS at a National or Regional level among participating countries; to explore the practical implementation and promotion of DS at a hospital level; to analyse different approaches in the functioning and organization of DS units with a particular focus on safety and quality. METHODOLOGY APPLIED AS PLANNED The first step of WP4 was aimed at obtaining solid information by means of a literature review. Therefore a peer and grey literature search was performed. On the basis of the literature review, three levels of investigation were identified for data collection and analysis: the National/Regional level, the hospital level and the DS unit level. At National/Regional and hospital level key informants were interviewed on strategic, political, organizational and operational aspects related to the two levels. For the DS unit level, in addition to formal interviews, the focus group method was also proposed in order to analyze key topics linked to the configuration and organization of work in a unit. The core themes were relevant to the communication systems with the patients (before, during and after the operation), to the patient satisfaction measurements, to the patient safety instruments used (including infections control) and to the training/continuous education system. DAYSAFE Deliverable N 10 - November

23 At a NATIONAL/REGIONAL level the following aspects of DS were investigated: Policies, strategies and plans; Financing and reimbursement; Human Resources; Standardization; Access; Output; Outcome; Safety. The interviews were conducted face to face or by telephone with key informants at a National/Regional level. The interviewers were the Project Leaders of the DaySafe project and members of the IAAS ( DaySafe collaborating partner). The HOSPITAL level was investigated in two ways: (1) using a questionnaire to be filled out independently and (2) by interview. The information providers were general directors or medical directors of the hospitals included in the study. The questionnaire allowed for the collection of important data such as the volume of day surgery activities, quantitative data on the physical infrastructure (e.g. beds, surgical beds, surgical beds dedicated to DS, operating theatres, operating theaters dedicated to DS, etc.); the different surgical procedures, hospital strategy for DS promotion, human resources for DS, data on DS access and satisfaction. These general elements contextualized the information which was then obtained through face to face interviews on the following issues of DS: Hospital Strategy; Methods for monitoring DS output; Methods for collecting data on DS mortality, wound infection and other complications; Obstacles for DS enhancement within the hospital; Key aims and tools with regard to patient safety; Routinely analyzed indicators; Ways to monitor productivity and costs generated by DS; Cost and productivity of DS staff; Comparison between outpatient and inpatient surgery. Interviewees were also asked to describe their methodologies in order to identify key elements of DS management at hospital level. At DSU level, in addition to a questionnaire, a focus group on three essential topics was proposed: Communication with the patients (before, during and after the intervention) and patient satisfaction; Patient Safety tools and strategies including prevention of hospital infections; Training and continuous education needs for DS personnel. The facilitators and the co-moderators of the focus groups were free to conduct the discussion as desired. Only some indications regarding key questions were given, most of them "open" and only two "closed". DAYSAFE Deliverable N 10 - November

24 The amount of information obtained through this study is impressive. The general objective of WP4 to assess the current organization and performance of DS across Europe as a first step in the identification of DS best practices and standards (WP5) has been fully achieved. The approach chosen for WP4 to investigate separately and in detail the three different levels necessary for the best functioning of DS was effective in that it revealed several specific key issues. In addition the tools used to gather the information from the participants proved to be correct: e.g. online questionnaires (for National level and for DS unit level), face to face questionnaires (for hospital level) and focus groups (for DS unit level). The conclusions of WP4 just represent an initial reflection on the data obtained which will be the base for the rest of the project and for WP5 in particular. INVOLVEMENT OF PARTNERS AND TARGET GROUPS Under the lead of Portugal, all participating Countries have been deeply and directly involved in the survey. WP4 Project Leader, Dr. Paulo Lemos, Immediate Part President of the International Association for Ambulatory Surgery (IAAS) decided to extend the survey to all members of the IAAS (DaySafe collaborating partner). PROBLEMS ENCOUNTERED The major difficulty encountered during WP4 implementation was the complexity and high number of data to be collected by each participating country. HOW WERE PROBLEMS RESOLVED The Project Management Team, in collaboration with a webmaster, decided to digitise all the questionnaires using an open source tool called LimeSurgery therefore facilitating the collection and insertion of data. Support from the expert in qualitative research consisting of online conferences, phone calls and direct interactions was crucial toward building a shared understanding of the protocol and its survey tools. ACTIVITIES PLANNED FOR THE NEXT PERIOD Collected evidence played a central role in the investigation of DS performance and was integrated by an analysis of its context. WP5 goes deeper into specific aspects of DS infrastructure and functioning. DAYSAFE Deliverable N 10 - November

25 Activities Tasks description Staff involved Timing Task 1 Analysis of DS organization and performance literature 1.1 Peer literature review Expert Team Public Health Physician HAS - CHP Medical Doctor HAS ARSN 1.2 Grey literature review Expert Team Public Health Physician HAS CHP Medical Doctor HAS ARSN From October to November 2010 Task 2 Research Protocol 2.1 Draft Expert Team Expert in quality research Medical Doctor EUROPMED ANAP Public Health Physician ADR 2.2 Discussion of draft with Associated and Collaborating partners Expert in quality research Medical Doctor NIHDI-CHP-SCJUT-MHH-ANAP-CAHTA-HAS-ARSN - ADR Public Health Physician AGENAS-ARSS-AOP-GZA-CHP-CHP SCJUT-MHH- EUROPMED From December 2010 to March Finalization of research protocol Expert Team Medical Doctor SCJUT Task 3 Task 4 Survey On line questionnaires - face to face or telephone interviews - focus groups Data analysis and Final report 3.1 Online questionnaires Expert Team Expert in quality research Public health physician MHH SCJUT ADR EUROP-MED Medical Doctor ADR - EUROPMED 3.2 Face-to-face or telephone interviews Expert Team Expert in quality research Medical Doctor EUROPMED-ANAP- SCJUT Public Health Physician ADR 3.3 Focus Groups Expert in quality research Expert Team Public health physician MHH-SCJUT-AGENAS Public Health Physician ADR Medical Doctor EUROPMED-ANAP-SCJUT Report on DS current organization and performance Expert Team Public health physician HAS EUROPMED AGENAS Public Health Physician ADR Medical Doctor EUROPMED ANAP From April to August 2011 From August to October 2011 DAYSAFE Deliverable N 10 - November Grant Agreement

26 WP5 Identification of DS best practices and standards NOTE: this work package is still ongoing WP5 goal is to identify best practices concerning DS key clinical and patient management processes and standards regarding key DS inputs, i.e. infrastructure, equipment and staff. For this project s purpose, a best practice is defined as a technique or methodology that, through experience and research, has proven to reliably lead to the most effective and efficient method of achieving an objective or task, drawing them from well-known leaders among DS systems and units. The concept of best practice offers a way to link together several conceptually related but independent disciplines in a way that potentially leads to performance improvement of health systems. A standard is defined as an established norm or requirement regarding DS resources. Special attention is paid to practices and standards with a demonstrated effects on safety improvement. Best practices and standards are identified through a benchmarking exercise, i.e. comparing top organizations, their processes and structures, and finding out the reasons why these distinguish themselves from the rest. Sources of evidence include both literature search and discussion with professionals and managers. HAS, the WP leader, has carried out an extensive review of the scientific and grey literature, which represents a fundamental contribution to the project s objectives Best practices and standards are identified through a benchmarking exercise, i.e. comparing top organizations, their processes and structures, and finding out the reasons why these distinguish themselves from the rest. Sources of evidence include both literature search and discussion with professionals and managers. HAS, the WP leader, has carried out an extensive review of the scientific and grey literature, which represents a fundamental contribution to the project s objectives and a knowledge basis of existing day surgery organization and clinical practices. The deliverable will include description of facility designs, staff and equipment, inventory of existing implemented organizational procedures such as (i) patient clinical pathway, (ii) staff coordination, (iii) patient information, (iv) general practitioner and community nursing service cooperation, (v) quality processes. HAS, will carry out a specific analysis on tariff setting mechanisms in France as a possible tool to foster DS development. The following step consists of interviews with key informants belonging to the International Association of Ambulatory Surgery (IAAS), national societies of ambulatory surgery and other established leaders at DS unit and system level. The recent involvement of ANAP (Agence Nationale d Appui à la Performance) with DAYSAFE has brought an important added value to the project. ANAP, which has substituted an Aneasthetist Unit of a Swedish hospital, has brought to bear a strategic perspective from one of the most important European countries. ANAP strictly collaborates with HAS, another central level prestigious institution of the French health system, by means of a formal agreement signed two years ago. These organizations are aware of the current gap in DS implementation DAYSAFE Deliverable N 10 - November

27 compared to the UK and the US and have identified this topic as one of the main priorities for the French health system. With the aim of gaining a deeper understanding of key success factors and barriers to DS expansion, ANAP and HAS have designed and are implementing a study, whose aim is to develop surgery without night stay through the design and promotion of organizational and professional best practices. More specifically, ANAP/HAS will select and study in depth fifteen DS units considered the best among the best in France. The selection criteria include a high volume and proportion of appropriate surgical procedures carried out as DS cases, a mono- or multi-disciplinary practice and innovative clinical approaches to complex procedures, e.g. hip replacement and breast resection. The investigation will tackle organizational dimension of DS, in particular factors which make possible progress with implementation, such as patients flows, jobs redesign and elimination of traditional beds. The study will also look into cultural factors, i.e. aspects which ensure acceptance of DS among both professionals and managers. Given the change in power and influence that DS introduces among professionals and administrators, especially the loss of control over a large number of beds and patients by directors of traditional wards, the cultural and political dimension are inescapable issues. As far as sources of information are concerned, the study will use both administrative information systems and ad hoc data collection through interviews and observation carried out during a visit of a duration of maximum four days to each unit. The investigation is thorough, in fact one of the most comprehensive research effort conducted by a European country on DS; however its schedule does not overlap completely with DAYSAFE. The most beneficial solution to this difficulty is to extend our project timetable. Lessons learned through WP5 represents a prerequisite of DS system design. DS managers and providers will have available a systematic collection of DS clinical and patient management processes and standards that will assist them in programming and managing systems and units. In fact the expansion of DS services delivery and the reduction of improvisation, delays and waste, imply systematic learning from the best DS units and systems. Best practices and standards will clarify key topics and make easier the progress toward implementation. In depth analysis of functioning DS units allows putting together relevant, practical and innovative best practices and standards linking different DS dimensions and various disciplinary perspectives. Still, learning is a necessary but insufficient condition. The next step is to institutionalise best practices, i.e. transform them in standard operating procedures (SOP) adopted by the organization and its members. Besides, design and adaptation of procedures to specific contexts need to consider the whole set of standardized processes and ways to ensure that they complete and support each other. Finally, procedures cannot be maintained for long and function properly, if they are not backed up by an overall, coherent system of policies. All these crucial issues will be considered by WP6, which represents the first step toward the design of strategic approaches to DS development. DAYSAFE Deliverable N 10 - November