Improving patient safety through hospital partnerships: APPS Overview and Lessons

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Stella York
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1 Improving patient safety through hospital partnerships: APPS Overview and Lessons Dr. Shams Syed Global Partnerships Lead WHO Patient Safety Programme Oslo, Norway - June 17, 2013

WHO AFRO Regional Committee Yaoundé, Cameroon 1. Develop and implement national policy for patient safety 4. Address the context in which health services & systems developed 7.

2 WHO AFRO Regional Committee Yaoundé, Cameroon 1. Develop and implement national policy for patient safety 4. Address the context in which health services & systems developed 7. Ensure healthcare waste management 10. Promote partnerships. 2. Improve knowledge and learning in patient safety 5. Minimize healthcareassociated infection 8. Ensure safe surgical care 11. Provide adequate funding 3. Raise awareness 6. Protect healthcare workers 9. Ensure appropriate use, quality and safety of medicines 12. Strengthen surveillance and capacity for research September 2008

3 Co-development built in to programme design

4 Three Core Objectives African Partnerships for Patient Safety European APPS Hospital African APPS Hospital Objective 1: PARTNERSHIP STRENGTH Objective 2: HOSPITAL PATIENT SAFETY IMPROVEMENTS Objective 3: NATIONAL PATIENT SAFETY SPREAD

5 What is a partnership? "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." APPS Definition of a Partnership

6 Patient safety improvement.striving for simplicity on the far side of complexity through partnerships

7 Context specific national spread VERTICAL: Political/Legal SPONTANEOUS HORIZONTAL: Expansion/Replication

8 A simple 6-step process

10 APPS: Kisiizi-Chester Patient safety action areas 1. HCAI 2. Health care waste management 3. Safe surgery 4. Medication safety Partnership Activities - Reciprocal partnership visits - Regular partnership calls - Technical input via Achievements - HCAI training/capacity building & HH implementation - Technical evaluation of HCWM system simple steps and infrastructure changes - Safe surgery systems improved - Drug and therapeutics committee established - Patient safety training manual developed - Presidential award!

11 Patient Safety Situational Analysis

12 Kisiizi, Uganda Innovative Processes

Human interaction making system change possible.

13 Where local meets global Increasing recognition of the partnership based approach WHO front page story! Human interaction making system change possible. Need to learn from local experiences if global systems are to change.

14 And the reality of APPS partnership work Partnership call February 2013 "There was a drug crisis confirmed by the Minister of Health and the Head of State. The Central Medical Stores did not have 95% of the essential drugs. It was so bad that the patients were kept without medication because the hospital did not have syringes, plaster, cannulars, sutures, IV Fluids, antibiotics, antimalarial, dental local anaesthetics etc. We saw unnecessary deaths that could have been prevented. Specialists and consultants were forced to write an open letter to the president and people of the republic of Malawi, without which the government would not have acted. At least now, we have a one month supply of these although some things for the laboratory have not been delivered. The truth is that the government's priorities are upside down."

15 And the reality of APPS partnership work Same Partnership call February 2013 "We welcomed Endalkachew and Fekade from Gondar University Hospital on 18 February. They are doing well. They participated in the production of ABHR at our pharmacy. On 19 February, they attended our IPC committee meeting where they learned our challenges and also they shared with us their challenges that are similar to ours. We also learnt from them how their pharmacy is organized and the handbook that they have produced which assist them in terms of which drugs to get first, quantities and so forth. Our drugs and therapeutics committee will emulate this. The beautiful thing is that the hospital director and the deputy hospital director responsible for nursing services (IPC inclusive) attended the meeting."

16 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.

17 Traditional versus partnership based approach Criteria of comparison Traditional APPS Frontline Needs Human resource requirement Technical support to deliver patient safety improvement in specific action area in African hospital WHO staff time for vertical technical assistance in selected health facilities Technical support to deliver patient safety improvement in specific action area in African hospital and securing mutual benefits to partner hospital Front line experts from partnership hospitals through donated time (institutional or personal) Implementation parameters Frequency of interaction Nature of interaction Usually one-off Response to technical request Continuous sustained engagement Technical human interaction passion channel Financial factors Substantial costs of WHO expert engagement. Travel costs for partnership exchanges.

21 Nine "Principles" learned from the "Developing World" Don Berwick 1. Simplify everything...complexity is waste. 2. Take teams seriously...uncooperativeness is waste. 3. Be pragmatic about measurement...too much counting is waste. 4. Strip the support system for improvement to a minimum...dependency is a form of waste. 5. Manage the political interface wisely... naivety is waste. 6. Help patients become advocates for change...keeping patients silent is waste. 7. Go quickly, start now...delay is waste. 8. Make spread a system...isolation is waste. 9. And finally, don't complain...complaint is waste.

22 THANK YOU For more information: Dr Shams Syed WHO Patient Safety

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Other Clinical Support services available on site include Oncology, Laboratory, Pharmacy, Physiotherapy and Audiology. BMI Albyn Hospital Quality Accounts April 2013 to March 2014 ALBYN HOSPITAL BMI Albyn Hospital is part of BMI Healthcare a leading provider of healthcare services throughout the UK. Located in the west