Post on 26-Jul-2020
African Partnerships for Patient Safety (APPS):
Lessons and Learning for Patient Safety
Webinar 4 of 6
APPS Webinar Series
Julie Storr
January 9, 2014
Review of Webinar 3
1. Outlined the linkage between "spread" and
national patient safety policy.;
2. Examined a WHO pilot tool for developing
national patient safety policy in the African
Region;
3. Described policy context in different
countries in Africa through case studies;
4. Articulated key lessons on patient safety
policy change.
http://www.who.int/patientsafety/implementation/apps/webinars/en/index1.html
Webinar 4 - Objectives
1. Outline the current and future mechanisms for sharing
patient safety improvement experience within and
between the APPS network
2. Articulate 10 key lessons from APPS partners over the
last four years
3. Through sharing of the 10 key lessons, describe how the
collective wisdom and experience can benefit those
starting the patient safety partnership journey
4. Introduce the APPS Evaluation Framework
Mechanisms for sharing
APPS network
Europe
Africa Rest of
the world
The knowledge sharing network of patient safety partnerships
The APPS Web Community Platform
An Online Forum
Access to an online
community
Chance to join
thematic discussions
Share experience
and learning
Receive quarterly
newsletter
An expanding online community
• 54 Community Members
• 1 Implementer
• 21 Countries
Thematic discussions
Ask questions – access a network of
experienced improvers
Share ideas
Follow the conversation
Learn
Experience and lessons shared
APPS News
Join us now
•Following registration to the
APPS Network you will
receive an email inviting you
to join the APPS Web
Platform;
•Join and be an active part of
this learning and sharing
network.
And - consider all media for learning &
sharing
The HIFA 2015 “Family” of discussion fora
http://www.hifa2015.org
HIFA CHILD 2015 email forum
http://www.hifa2015.org/child2015-forum/
HIFA - Portuguese
http://www.hifa2015.org/hifa-pt/
HIFA - Zambia
http://www.hifa2015.org/hifa-zambia/
HIFA - EVIPNet-Francais
http://www.hifa2015.org/hifa-evipnet-francais/
Other Partnership Focused Organizations
http://www.esther.eu
http://www.thet.org
http://www.esther.fr/en/
And….Social Media
Learning together
Patient Safety
Partnerships
Patient Safety
Improvement
Patient Safety Spread
APPS Compendium of Experiences & Momentum Report
http://www.who.int/patientsafety/implementation/apps/resources/en/index.html
10 lessons for patient safety partnerships
SUMMARY
Lesson #1: Identify the patient safety problem
• Patient Safety Situational
Analysis
• Set small achievable goals (2-5
Action Areas seems optimal)
• Choose inter-related Action
Areas
Gondar University Hospital, APPS Site Visit Report 18 | P a g e
“Practice i
s
n ot difficult fo r h and hygiene. Most of us know what to do. It is a problem with attitude where some workers do not make it a priority to wash hands” Surgical ward nurse
Structural Challenge:
Lack of sustainable
approaches to ABHR
production Alcohol Based Handrub has been
produced by the Gondar pharmacy staff
and utilized on various wards at Gondar
Hospital. However, sustainable methods
to produce the ABHR has been a
challenge. Due to limited space and
poorly constructed buildings, the
pharmacy staff has struggled to delineate
a sterile space for ABHR production.
The supply for the WHO recipe ABHR
ingredients were utilized for the first
ABHR launch, however, the pharmacy
staff has a keen interest in using a
sustained approach towards ABHR
production. The area that was used for
ABHR production is located in the same
area where boxed supplies are currently
located. Aware of the need for a more
streamlined and sterile approach to
ABHR production, Gondar lead
pharmacist, Endalkachew Admassie will
be traveling to Central Kamuzu Hospital
in Malawi in January 2013 to directly
observe their sterile area and learn how
to produce the ABHR in a sterile
manner.
Figure 1: Lead Gondar pharmacist, Endalkachew
Admassie holds a bottle of ABHR produced at
Gondar University Hospital. The area behind him
shows the non-sterile area where it was produced.
Despite ABHR production, the
distribution of ABHR equally on
medical and surgical wards has been
inconsistent. Observational survey data
showed how only one bottle of ABHR
was available on the orthopedic ward.
The ABHR was located in the corridor,
however, far from many patient bed
areas. Healthcare workers stressed how
lack of time due to nursing duties
prevented them from utilizing ABHR on
a consistent basis. Distance from patient
areas was also a common answer when
healthcare workers were asked about
barriers to ABHR use. Partners in UHL
had introduced personal-sized containers
for each health worker, however
malfunctioning flip tops on the
containers led to the ABHR spilling into
workers pockets. Currently, there are
bags full of empty plastic personal sized
containers in the supply area next to the
ABHR production area. Focus group
interviews revealed a strong interest in
having personal sized containers for
ABHR.
Lesson # 2: Convince others of the need to act
• Early institutional
engagement
• Use Situational Analysis
• National: Ministry of Health;
WHO; NGOs; Media;
Community
• International: Private
Organizations for Patient
Safety and alcohol based
handrub example
• “Healthcare is expensive. A
ny efforts to protect the health
of the patient and improve
patient safety in the hospital
will make our care more cost-
effective,” APPS Team member, Pharmacist
Lesson # 3: Patient safety improvement is not just another project
• Integrate with existing
frameworks
• Emphasize mutual
benefits, global learning
and local benefits for
patients
• Measurement is hard-
wired into the approach
Lesson # 4: Building a patient safety culture takes time (don’t be over-ambitious)
Small achievements can help build a
culture of safety:
■ Patient bill of rights, Healthcare worker bill of
rights displayed in clinic areas
■ ABHR for each healthcare worker – empowerment
“Even something as small as
personal towels for nurses, empower
us and make us feel important”
11 | P a g e
Central Kamuzu Hospital, APPS Site Visit Report
“People need t
o
constantly b
e
reminded about hand hygiene, especially our healthcare workers. To empower the patients themselves to remind us to wash our hands is essential and for this to happen, patients need to know their rights” APPS Lead, Dr. Jessie Mlotha
Key Achievement: Empowering Patients to
Demand Safe Care
Despite the challenges faced at Central
Kamuzu, the APPS team has made
several achievements in patient safety.
Change is often slow and cultural shifts
can be critical components in the
promotion of sustainable approaches.
Sharing these reverse innovations with
other APPS partners could provide a
mechanism to promote meaningful
change and promote patient safety
spread.
Understanding the importance of
empowering the patient and community,
APPS has promoted the use of poster
reminders in-patient waiting areas to
educate patients and empower them to
demand safe care. The APPS team
understands that simultaneous
approaches in patient safety include not
only procuring basic infection
prevention supplies, but also promoting
cultural shifts within the hospital
community.
Figure 4: Patient Bill of Rights and Responsibilities
in local language posted outside clinic patient
waiting areas.
APPS team members highlighted how
community engagement and engaging
the patient directly in the dialogue on
hand hygiene is critical for progress in
patient safety. One dental surgeon told a
story about how a patient asked him
prior t
o
st arting hi s ex amination, “Did
you wash your hands w
i
t h so a p?” Th e
recognition of patient rights in
healthcare delivery through visual
reminders in clinic areas can empower
patients directly and hold all healthcare
staff accountable for infection
prevention. These cultural shifts are
often slow, but critical tipping point
moments such as these that can influence
cultural ideologies about quality health
care services. If patients can advocate
for themselves, this can be a more
sustainable way to influence compliance
in hand hygiene.
12 | P a g e
Central Kamuzu Hospital, APPS Site Visit Report
Key Achievement:
Innovations to Reduce Waste
Innovations to reduce waste in an
already overburdened system reveal how
the APPS team has developed
sustainable approaches to measure
utilization of ABHR. Despite lack of the
ABHR solution, it was rare to see a
healthcare worker without a personal-
sized ABHR container clipped to their
white coat. During focus group
interviews, health care workers
expressed how empowered they felt
having their own personal ABHR
container and it was evident from the
APPS data that utilization of ABHR on
specific wards was better in some than
others. The next steps would be to
continue using the pharmacy as a data
collection station as staff come to
restock their ABHR supply. Subsequent
projects could involve analyzing why
certain wards are not utilizing the ABHR
as often and exploring means to promote
hand hygiene compliance in a targeted
manner.
Figure 5: Personal ABHR clipped to white
coat of healthcare worker.
When the pharmacy staff at Central
Kamuzu was successful in developing
the WHO recipe ABHR, there was a real
enthusiasm among the healthcare staff to
use the ABHR. Dr. Jessie Mlotha, APPS
Lead, in coordination with the South
Tees NHS Trust hospital partnership was
able to procure 500 personal-sized
plastic containers with a surgical clip.
Despite the lack of ABHR supply
currently at Central Kamuzu, it was not
uncommon to see many healthcare staff
clipped with an empty plastic ABHR
container to their coats. The added
benefit of such an innovation was with a
goal to reduce plastic waste since waste
management is a serious challenge on
the hospital grounds. During focus group
interviews, many staff members were
frustrated that there was a good supply
of ABHR for months, followed by
challenges in basic supplies leading to
cessation of ABHR production.
“The i
d
ea was th at each he althcare worker could have their own alcohol hand rub attached to their coats. When they would run out of the hand rub, they would go to the central pharmacy and refill their bottle. This would also be a way to track data on which wards are using how much hand rub” APPS Lead, Dr. Jessie Mlotha
Lesson # 5: Awareness of context and the need for adaptation are critical
• Agree roles at the start
• Contextual challenges must be taken into account
• Infrastructure
• Human resources
• Data collection and surveillance
• Community engagement
• Culture
• Consider unintended consequences
Lesson # 6: Keep it simple
• Simplify interventions
• Policies and guidelines – a
good start (co-development
across partnerships)
• Front-line realities taken into
account
• Adapt the 6-Step cycle
• SMART plans
• Choose simple starting points
Lesson # 7: Improving safety and quality is a team sport
• Build a strong core team
• Then build smaller teams
• Use all available data
• Measurement is important – small results have big impact
• Visits help build momentum
• Individual passion motivates teams
• Celebrate success
Lesson # 8: Knowledge is the enemy of unsafe care
“Patient safety tools are simple, but
behavior change is difficult. These
are new concepts for us and
through persistent education we
can
promote shifts in our hospital cul
ture”
Nursing Patron
• Sensitize healthcare workers
through training and education
• Start with basic principles of
patient safety
• Develop contextual training
materials
Lesson # 9: Communication
• Highlighted as the single most important success factor
• Schedule regular communications and protect time
• Agree the preferred mechanism
• Post-visit follow-up communication is key
• Joint visit reports
• Communicate across the partnership
Lesson # 10: Clinical leadership and engagement is important (local and national)
• Early engagement with executive decision makers
• Sell the benefits across the hospital
• Senior hospital leaders as part of the patient safety team
• Engage national decision makers
• Use national events to launch/communicate about patient
safety
AND…..The APPS Evaluation Framework
Evaluation focused on the three programme
objectives:
■ Patient safety improvement
■ Partnership strength
■ Patient safety spread
A wealth of additional learning
Join APPS Webinar 6 to hear a synthesis of the
evaluation results so far.
SUMMARY POINTS
1. APPS provides a mechanism for sharing patient safety
improvement experience
2. Systematic analysis of existing partnerships has resulted
in 10 broad lessons for improvers that can aid
partnership work
3. The collective wisdom and experience is growing every
week – you can be part of this
4. The APPS Evaluation Framework webinar 6 builds on the
lessons presented here
THANK YOU
Please visit our website to find out more about
the programme and access our resources
www.who.int/patientsafety/implementation/apps