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User guidance

This presentation can be used to train nominal group technique facilitators (slides can either be projected or distributed in hard-copy)

The slides can be used to train candidates with no training or experience in facilitating nominal group meetings (at least one day of training), or to conduct a refresher course for trained and experienced facilitators (at least a half day refresher): the content is the same but the pace of work varies

Train more facilitators than actually required, so as to select the most promising candidates and compensate for drop-outs. Use functional criteria to select candidates: e.g. level of education, professional experience and attitudes.

Deliver this training approximately one week before the meeting but start preparing it early (rehearse, prepare training materials, etc.)

Adapt the slides to local requirements if needed Distribute a method protocol to each participant at the beginning of the session Speak slowly and clearly, avoid creating a ‘teacher-student’ impression,

encourage discussion, and ask questions to ensure optimal understanding Provide further training if necessary

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Nominal group meeting facilitators training pack

<insert your name, position and affiliation>

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What and how will you learn?

What: Patient safety and WHO's initiative Key concepts of patient safety The objectives and processes of nominal

group meetings Your role as a meeting facilitator How to excel in your role: do's and don'ts

How: Facilitator-led presentation Questions and discussions Quiz Hands-on exercise

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What is patient safety?

Freedom from accidental injuries during medical care

Activities to avoid, prevent or correct any adverse outcomes which may result from the delivery of health care

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Why is patient safety important?

Every year tens of millions of patients suffer disabling injuries or death due to unsafe medical care

In developed countries 1 in 10 patients is harmed while receiving hospital care

We know little for developing countries but evidence suggests that they are even more affected by patient harm

The consequences are millions of devastated lives and billions of dollars unnecessarily spent on prolonged hospitalization, loss of income, disability and litigation

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The initiative of the World Health Organization

Against this backdrop, the World Health Organization called into life the World Alliance for Patient Safety in 2004

The Alliance pays particular attention to patient harm in developing and transitional countries

Since fact-based knowledge is often rare in such contexts, the Alliance has developed simple methods to help local practitioners and researchers assess and tackle patient harm in data-poor environments

You can contribute to successfully conducting one of these methods by acting as a nominal group meeting facilitator

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Key concepts

Unintended injury or complication

Prolonged admission, disability at discharge or death

Caused by health care management rather than the disease process

May or may not be preventable or caused by negligence (e.g. post-operation wound infection)

Harmful Incident (HI)

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Key concepts

Harm would not have arisen if standard levels of care had been used

or

An incident is preventable if reasonable steps to prevent this occurrence can be identified

Preventability

A factor in an event, effect, result or outcome which is similar to a cause and can relate to the Patient (e.g. co-morbidities) Task (e.g. lack of guidelines/

protocols or their use) Individual (e.g. lack of

knowledge) Team (e.g. poor team-work) Environment (e.g. defective or

unavailable equipment) Organisation (e.g. poor co-

ordination of overall services)

Contributing factor

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What is a nominal group meeting?

Why: to understand causes of Harmful incidents

What: a meeting aimed at gathering together the experiences and ideas of local health care staff through goal-oriented brainstorming

Who: the meeting is led by a trained facilitator

the participants representing all activities of a health care facility

How: the facilitator can use talking points to conduct the meeting

How long: the meeting requires 1.5 to 2 hours

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• briefly introduce yourself • conduct an “ice breaker game”, or invite participants to introduce themselves • explain objective: to gather views in order to develop an action plan • purpose is to improve facility’s work, not to test participants • explain that the discussion is confidential

Introduction

• explain that an HI is an “unintended injury that results in temporary or permanent disability, death, prolonged admission or financial loss to the patient, and which is caused by health care rather than the disease process.”

• provide examples of HIs if needed (p. x of method protocol) and answer questions, but limit discussion to 15’

Define HIs

• explain the structure of the meeting:• identify HIs observed in this facility• identify contributing problems • identify problems that contribute to several

HIs• score problems that contribute to several HIs• agree on the most important contributing

problems• ask: “What kind of patient harm have you witnessed that was

caused by failure to provide care, by inappropriate or inadequate care being given, or by care being delivered wrongly?”

• ask participants to write down the 2-3 most serious and avoidable HIs on their sheets and communicate these in turn, with one HI per round (note these in the “HIs” column)

Identify HIs

Explain meeting

procedure

Meeting procedure

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• ask participants to identify and note on their sheets problems that contribute to the first HI written on the whiteboard

• ask them to communicate their results in turn (note these in the “contributing factors” column)

• proceed in the same way to determine the contributing problems for all HIs

Identifycontributing

problems

• explain that one health care mistake can lead to several HIs • ask participants to identify problems that contribute to several HIs (write

these down in the “problems contributing to several HIs” column)

Identify common

contributingproblems

• ask participants to score common contributing problems: scores range from 1 to total number (worst contributing problem receives highest score)

• explain criteria: frequency and seriousness of contributing problem, acceptance and feasibility of solution (most important criterion = cost)

• ask participants to communicate their scores (note these in “score” column, one column per participant)

• count score attributed to each common contributing problem• ask participants to discuss the final ranking, so that everybody agrees• change order of two contributing problems or conduct vote if needed • discuss and note final ranking (in “final ranking” column)

Rank common contributing

problems

Score commoncontributing

problems

Meeting procedure (continued)

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How to conduct your tasks: do…

ensure that no meeting has less than 5 or more than 12 participants

inform participants of the meeting objectives and process, thoroughly explain the definitions

inform participants that the objective is to gather their input and not to test them

be flexible but follow the suggested meeting procedure and time plan whenever possible

find a balance between being too passive (e.g. not focusing on key questions) and too controlling (e.g. inhibiting spontaneous participation)

pay equal attention to all participants and ensure everybody can freely express himself/herself

leave participants enough time to think listen carefully to what participants say and ask them to

repeat or be more precise if necessary speak slowly and use simple language ask questions to assess participants' understanding use follow-up questions to fully explore each question be aware that participants might follow the chorus of

opinions and try to hear their individual views

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How to conduct your tasks: don’t…

be nervous: there is no reason if you are well prepared forget that the primary objective is to assess the situation and not to

teach how things should be done waste time on marginal topics let the discussion be dominated by a few ask embarrassing or unnecessary questions pressurize or blame participants try to influence participants’ answers or ask ‘leading questions’ (e.g.

‘This is the most important HI, don’t you think?’) forget to note participants' answers (in the pre-prepared tables)

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Questions? Comments?

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Quiz

Instructions

Not a pass/fail test but an opportunity to identify areas that require further discussion or training

Participants discuss the questions in small groups (you can use your method protocol), followed by each group presenting its answers and a general discussion led by the facilitator and aimed at clarifying potential questions

Questions

Explain the concepts of patient safety, HIs, preventability and contributing factors in your own words and give examples for each

Summarize the objective and process of a nominal group technique meeting

Describe the tasks you will be performing step-by-step

Discuss how to best ensure that the do‘s and don‘ts are respected

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Hands-on exercise

1. Participants split into small groups. A facilitator is selected for each group and the rest of the group act as meeting participants.

2. The facilitator conducts the first phase of the meeting (introduction), and is then replaced by another facilitator who conducts the second phase (explaining the meeting procedure), and so forth, for each phase.

3. The group gives each facilitator feedback and ensures that everybody has acted as both facilitator and participant.

4. At the end of the exercise, each group explains the problems they have faced and the lessons they have learned. The trainer clarifies potential questions.

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Further information

For further information, questions or comments contact

<insert your name and telephone number or email> Visit the Patient Safety Programme (Research) website at:

http://www.who.int/patientsafety/research/en/