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