Post on 26-May-2020
African Partnerships for Patient Safety (APPS): Improvement Framework
Webinar 2 of 6
APPS Webinar Series
November 7, 2013
Dr. Shams Syed
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.
http://www.who.int/patientsafety/implementation/apps/webinars/en/index.html
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.
The APPS Framework
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)
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. Healthcare-associated 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
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. Healthcare-associated 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
The Improvement Continuum and APPS
Patient Safety Improvement: Emerging Learning from APPS Implementation
Learning Area Learning Point
Simplicity vs.
Complexity
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.
Patient Safety Teams 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.
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.
Systematic Process 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.
Measurement 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 vs.
Systems
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.
Knowledge and
Learning
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.
Basic Infrastructure 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.
APPS 6-Step Process & Key Tools/Resources
A simple 6-step process…
APPS 6-step process: Supported by co-developed tools & resources
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
"If I had eight hours to chop down a tree, I'd spend six sharpening my axe." - Abraham Lincoln
Step 1: Partnership Development
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.
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.
"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."
Step 1: Core Resource APPS Partnership Definition
• Shared vision & joint planning
• Ownership
• Relationships
• Communication
• Ways of working
Step 1: Additional Resource Principles of Partnership
Step 2: Needs Assessment
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
Step 3: Gap Analysis
• 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.
Step 3: Core Resource
Improving Patient Safety: First Steps
Example "First Steps":
Action Area 8: Safe Surgical Care
• 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
Lobby for national policy, develop local
policies
• Identify and develop leaders for safe surgery. Develop Leaders
• Consider how to establish or strengthen mechanisms to record hospital deaths or complications following surgery
Improve the system for record
keeping
• Consider how to establish hospital data capture mechanisms that measure key parameters of safe surgery in hospital operating rooms
Focus on measurement
Step 4: Acting Planning
Step 4: Core Resource
Step 5: Action
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.
What do we mean by a Resource?
• Guidance
• Policies
• Publications
• Templates
• Toolkits
• 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
• 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.
Level 2 • 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
Navigating the Resource Map
Step 6: Evaluation & Review
• 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.
Step 6: Core Resource APPS Evaluation Handbook
Hospital patient safety
situational analysis
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
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.
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?
Part 2: Hospital Information
• General
information
• Workforce
snapshot
• Infrastructure
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
Example – Short Form
Action Area 1: Patient Safety & Health
Services/Systems Development
Example – Short Form
Action Area 3:
Knowledge & Learning in Patient Safety
Example – Short Form
Action Area 5:
Health care associated infection
Example – Short Form
Action Area 10:
Patients and Communities
And the Long Form…
Final Reflections
Summary Points
• The APPS Framework can be utilized for patient
safety improvement through utilizing hospital-to-
hospital 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!
THANK YOU
Please visit our website to find out more about the programme
and access our resources
www.who.int/patientsafety/implementation/apps