Dimitrios ZIKOS, Marianna DIOMIDOUS, John MANTAS

1. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines European Union Network for Patient Safety (EUNetPaS):A framework for the development of Patient Safety Education and Training Guidelines Dimitrios ZIKOS, Marianna DIOMIDOUS, John MANTAS Health Informatics Lab, National and Kapodistrian University of Athens jmantas@cc.uoa.gr

2. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines The importance of Patient Safety within Healthcare • Within healthcare settings, adverse events and medical errors are relevant causes of harm, injury or even death to patients. • Patient Safety is “the freedom for a patient from unnecessary harm or potential harm associated with healthcare” and inevitably it is a serious concern in the EU. • Healthcare organizations should make Patient Safety a declared and serious aim, by establishing comprehensive programs with defined executive responsibility, operated by trained personnel and in a culture of safety.

3. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Issuing the problem of Patient Safety • Adverse events occur in all health care settings. • 10–16% of hospitalized patients experience an adverse event related to clinical care, with a mortality rate in these patients of 5-8%. • Adverse events occur in around one out of ten hospital admissions but it is difficult to obtain exact numbers because there are only few in-depth studies on this. • It is evident that similar types of medical errors happen in all healthcare systems.

4. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Evidence Base • In 1991 an early investigation into the number of adverse events in healthcare was published in Harvard University. The study showed that 3.7% of the hospitalized patients in New York had experienced an adverse event and 13.6% of these had died as a consequence. • In 1995, another study in Australia showed that 16.6% of patients in Australian hospitals had experienced an adverse event. • During the last decade, many other countries have carried out their own studies issuing the size of the problem. • The “Swiss cheese model”, aimed to understand the causes of adverse health effects.

5. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines The EUNetPaS Project • The European Union Network for Patient Safety (EUNetPaS) is a project funded and supported by the European Commission within the 2007 Public Health Programme. • It started on 1st February 2008 and it has a 30-month duration. • The project unites representatives of the European medical community (physicians, nurses, pharmacists, managers, patients’ associations, etc.) and the institutional partners involved in Patient Safety with the EU states (members of national PS organizations and Member States’ Ministries of Health). • EUNetPaS aims to establish an umbrella network of all EU Member States to encourage and enhance their collaboration in the field of Patient Safety (culture, reporting and learning systems, declaration of adverse events, education &monitoring PS), thus maximizing efficiency of efforts at EU level.

6. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines EUNetPaS focus areas EUNetPaS aims to • Promote a Culture of Patient Safety. • Support education and Training in Patient Safety in Member States through mutual exchange of experience and knowledge on learning interventions for healthcare professionals. • Propose of a Core European curriculum for PS in higher education and as part of continuing education taking into account patients and health care professionals needs. • Implement Reporting and Learning Systems for the identification, collection and structuring of PS information within the EU. • Pilot Implement Medication Safety to improve medication safety in hospitals by identifying good practices, translating them into tools and testing these tools in selected hospitals.

7. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Education and training in Patient Safety • One of the major objectives of the EUNetPaS project is to promote PS education and training in Europe through common principles and values. • This scope is succeeded through a platform for the mutual exchange of experience and knowledge on methods of planning and implementing sustainable learning activities for healthcare professionals and of involving patients and caregivers-through awareness and education programmes. • A secondary scope refers to reaching workforce planners in healthcare settings and decision makers in Universities to promote the integration of these learning methods and activities in curricula. • Patient Safety education activities in EUNetPaS are considered as part of Continuing Professional Development (CPD) programmes for health professionals. • Towards the achievement of these goals, a common platform for the exchange of knowledge on Patient Safety Education and Training Activities has been decided and developed by the EUNetPaS team, in order to support information collection and sharing in Europe. • Based on a robust set of collected good practice examples, a Guidelines document was decided to be developed in order to support those who plan to design and implement a Patient Safety education and training activity.

8. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines A framework for the development of PS Education & Training Guidelines

9. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines General Considerations • Making the shift to collaborative & multidisciplinary care has been the response for dealing with fast knowledge production & over-specialization. • The globalization of healthcare delivery has required educators to recognize the challenges of preparing medical and nursing students who are able to work in their country or in other healthcare systems. • The mobility of health professionals in Europe and globally has produced many opportunities for enhancing education with consolidation of best practices in what concerns curriculum development . • By recognizing the above mentioned challenges, it is of great importance to provide guidance to all those people that teach or plan PS activities. • In order to succeed, the guidance provided in all healthcare settings, needs to be based on some principles.

10. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines General Considerations (cont.) • The guidelines must be of relevance to all stakeholders concerned with PS and therefore the scope is wider than that provided by formal learning activities. • The PS curriculum requires that all stakeholders work across the organization in a collaborative way, embrace the requisite knowledge, attitudes, and skills for PS and recognize appropriately the learning, both practical and theoretical, that emerges. • Learning is not just an outcome of social interaction but it is integral and inseparable from all activities. These are suggestions for the design, development, delivery and evaluation of a learning activity. The process should be applicable at foundation (undergraduate) level, Masters (post-graduate) level, in a university or in the workplace. Taking a systems based approach will ensure that the appropriate activity is matched to the needs of participants.

11. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Teaching Objectives • The teaching objectives set in the Guidelines should be defined by keeping in mind that they are closely related with the expected learning outcomes. EUNetPaS identified the main teaching objectives 1st Objective The acquisition of foundation knowledge, behaviours and skills for PS. This objective is expected to facilitate the appreciation of the systemic nature of risk, to deepen knowledge in key areas of PS, and to help recognise the need for proactive planning to avoid error. 2nd Objective Reassurance of PS. The expectations that derive from the fulfilment of this objective are the engagement in learning from errors & near misses, broadening opportunities to collaborate, promotion of innovation about PS and the engagement in personal development for continual improvement via own learning. 3rd Objective Adoption of systems based working. The recipient of the teaching program is expected to take a systemic approach to problem solving, apply improvement principles, utilise tools and techniques of systems improvement and promote a culture of change. 4th Objective Enabling Patient Safety Culture, by taking a proactive approach to PS. 5th Objective Setting a direction for quality and safe healthcare, towards the identification of opportunities for improvement, evidence based approach, working with stakeholders and implementing impact evaluation.

12. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Identifying the different recipients • A guidance document for those who plan to teach PS should clearly set the different categories of healthcare staff, due to the fact that they share different roles within the healthcare context. • All stakeholders require a foundation level of understanding, but there are greater depths required of other practitioners. • Those directly involved with patient care (nurses, doctors, allied health professionals etc) will require a high level of competence in the field of PS, but new employees and those who are not directly involved in patient care (support staff; managers etc) may require a standard level of competence, although they will still require some understanding of the significance and practice of PS. • Policy makers & sponsors equally require a less in-depth understanding of the PS operation but they require significant understanding of policy & regulatory issues. • Inevitably, those who assist in building the understanding of others need to have the highest level of competence in the field of PS.

13. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Identifying the different recipients (cont.) The above mentioned broad categories can be organized in 5 groups: • those who sponsor • those who design curricula and teach • those who provide core services • those who provide support services • the patients/carers/users • For each one of these categories, the role-specific expected outcomes, the indicative content, the prerequisites and proper good practice examples are provided. Note: the groups are not hierarchical and there is no overt progression from group to group.

14. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Content of a teaching program: key areas • Regarding the content of a PS Education and Training programs, those who provide guidance or implement Education and training activities should focus on specific key domains and action fields of Patient Safety. These domains include • the creation of a safety culture, • the identification and measurement of problem fields (PS epidemiology), • cause analysis of adverse events and near misses, • the management and coping strategies for adverse events and near misses and • the prevention of errors. • These are the main fields that should be distinctly described as a guidance to actually ‘build’ the whole content of the education material. • Knowledge, attitudes, skills and the needed learning activities to build them, must be developed according to responsibilities rather than on professional groupings. • A guidance document should propose that the content of the planned activities should be diversified, including case studies, always staying tailored to the specific context of use. • Specific guidance on how this may be done can be offered by examples of learning activities applying the same principles applicable to different audiences and contexts.

15. Web version of the Guidelines

16. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Scope of the Web version • In order to make the guidelines document widely available, an extended web version has been developed to enable the clean presentation of the guidelines on a networking environment as well to provide practical examples. • The benefit of the web version is that it succeeds to inter-relate the navigation through the knowledge base/good practice examples with the submission of new case reports. • Those who have already used the guidelines document in order to implement their own PS Education and Safety intervention have the option to directly input information on their own activity within the web portal. • Consequently the good practice examples section of the web portal provides interactivity and enables the dynamic, up-to-date inclusion of cases, based on specific input criteria, provided through an online form. • The web portal is currently being consulted by Patient Safety experts and is planned to be publicized on a second stage.

17. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines • Welcome Page • European Countries and Education & Training • Navigation Panel

18. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Linkage with the Education and Training Activities ! The submit process should follow a “decentralized” approach. Each EUNetPaS member should be able to submit an activity within his own Network

19. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines In Detail: General Guide

20. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines In Detail: “Who is involved” Section • Direct link with relevant • Stories • Context • Example

21. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines In Detail: “How it is organised” Section • Theoretical Base • Knowledge-Skills and Behaviours for Patient Safety

22. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines In Detail: the “Design-Delivery” Section Link to content…

23. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines

24. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines In Detail: The “Evidence Base and Links” Section

25. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines

26. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Impact assessment of the Guidelines • The guidelines document is being assessed in relation with certain points that are considered to represent the main focus and expected outcomes of the guidelines use. • In the impact assessment process there has been close collaboration between a group of researchers responsible for the assessment of the whole EUNetPaS project and the partners responsible for the PS Education and Safety. • The questionnaire is being distributed across National Contact Points involved with the development and use of the guidelines. • The results of the impact assessment will be presented in a report by the end of the EUNetPaS project. The questions for the impact assessment of the Guidelines are the following: • Are the Guidelines useful? • Do you consider modifying your curricula based on the Guideline findings? • How could the Guidelines be improved? • To what extent do the guidelines succeed to inspire foundation knowledge, encourage behaviors and skills, assure PS, help to enable a PS culture etc?

27. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Discussion • The horizontal approach followed for the design of approach PS education and training activities will allow a focus on the specific needs of the different roles involved in healthcare. • This is succeeded by methodically applying the principles and the general context that has been presented, within the curriculum/activity plan. • The expected outcomes of a well designed and implemented activity is the success to develop a mindset for improving PS, maintain a culture for PS, focusing on continuity of care and enable healthcare environments to become learning organizations. • Throughout the proposed and already implemented into actual guidelines document structure, a web version has been developed. • The portal aims to bring together the learning/planning process with the good practices interactivity, thus providing a non-linear, dynamic tool, which supports the continuation of planning PS education and training activities.

28. EFMI Special Topic Conference A framework for the development of Patient Safety Education and Training Guidelines Acknowledgments. EUNetPaS project is partially funded 2008–2010 by the European Commission (NoA/100861) in the Public Health Executive Agency. Project partners are: Haute Autorité De Santé – HAS (FR), Stichting Kwaliteitsinstituut voor de gezondheidszorg – CBO (NL), National and Kapodistrian University of Athens – NKUA (GR), National Board of Health – SST (DK), European Hospital and Health Care Federation-HOPE (BE), Ministry of Social Affairs and Health – STM Finland (FI), Comité Permanent des Médecins Européens- CPME (BE), European Society for Quality in Healthcare – ESQH (IR), Pharmaceutical Group of the European Union – PGEU (BE), Institute of Health System Research,University of Linz – IPG (AT), Spanish Ministry of Health and Consumer Affaires (ES), Health Information and Quality Authority – HIQA (IR), German Coalition for Patient Safety – GCPS (DE), Service Public Fédéral Santé Publique, Environment et Sécurité de la Chaîne Alimentaire– FOD-DG1 (BE), State Health Care Accreditation Agency – StaHeCCA (LT), National Board of Health and Welfare – NBHW (SE), Department of Health, Ministry of Health – DGS (PT), Stichting Katolieke Universiteit, Radboud University Nijmegen Medical Centre – RUNMC (NL), The European Federation of Nurses Associations – EFN (BE), Department of Health – DoH (UK), European Patients’ Forum – EPF (LU), Research Center for Biomaterials – EKEVYL (GR). Thank you!