International Perspective and Conclusion Gérard Schmets WHO EUROPE

1. International Perspectiveand ConclusionGérard SchmetsWHO EUROPE

2. Global health indicators are improving overall in the world… But not in all places, not for all social groups and not at the same speed

3. Life expectancy at birth, males, 1970-2002 80 75 EU(15-prior 1.05.2004) average CIS(12) average 70 Life Expectancy at birth, in years 65 60 1970 1980 1990 2000 2010 Source: Health For All Database, July 2004

4. Of course, empoverishment explains a big part of these results… but not all!

5. Inter-country variations in levels of mortality in 67 developing countries explained by indicators of care and context 100 Unexplained variation 90 Variation explained by financial inputs and responsiveness 80 70 Variation explained by human resource density 60 % of variation explained 50 40 Variation explained by interaction between care and context 30 20 Variation explained by contextual factors 10 0 Infant Mortality Postneonatal Mortality Neonatal Mortality Maternal Mortalityl Fuente: World Health Report 2005, pg 83,

6. health has to do with: health system effectiveness economic development democracy and values

7. Can anything be done to accelerate health gain?

8. Strengthening Health System saves lives

9. Health systems framework FUNCTIONS THE SYSTEM PERFORMS Health (level and equity) Stewardship (oversight) Creating resources (investment and training) Responsiveness (to people’s non-medical expectations) Delivering services (provision) Financial protection and fair distribution of burden of funding Financing (collecting, pooling and purchasing) Performance

10. Health System Frameworkto Improve Safety Exercise Stewardship Finance the System • Assess cost of errors • Financial incentives for performance according to standards • Invest in safer care interventions • Evidence-based policies • Non-punitive error reporting system • Supportive supervision and control Safety Issue: Accidental Death Generate Resources Organize Service Delivery • Computerized reminders • and alert systems • Evidence-based guidelines, standardized procedures and safety interventions • Team-based quality improvement projects • Computerize medical records • Medications with bar-codes • Train staff in reporting errors • Special certification in critical care

11. QUALITY & SAFETY:KEY ELEMENTS

12. In European Hospitals: ‘Every 10th patient suffers from preventable harm’ (it is suspected this is higher at Primary Health Care level)

13. Possible reform Function Computerized reminders Service Delivery Evidence-based guidelines New GP and family nursing curricula Resource Creation Renovate and equip maternity services Introduce incentives for performance Financing Invest in safer care interventions Monitor compliance with new guidelines Stewardship Promote non-punitive reporting & safety culture Identify actions that lead to objectives Intermediate objectives National objective Reduce accidental deaths Improved safety in antenatal and delivery care Improve patient safety Improved access to safe delivery services Strengthen Safety Culture

14. International agencies support World Alliance for Patient Safety In Europe, EU, EC, CoE, OECD, WHO-Europe WHO-EURO: PHC: QI at country level HOSPITALS: PATH project (Performance assessment tool for quality improvement in hospitals) IN PRACTICEOn the International Agenda

15. SITUATION IN EUROPE:WHO EUROPATIENT SAFETYSURVEY

16. Respond to identified need to fill the information gap • Target: 52 members states • Questionnaire based • Raising awareness on patient safety • Identifying national focal points • Evaluating major problems at national and regional levels A European baselinesurvey on patient safety Aims:

17. Overall response rate: 76.9% The first to respond: new EU and accession countries The lowest response rate: NIS

18. Fragmented interventions Gap between policy and implementation Unclear reporting schemes & data use Patient expectations are high Need for consistent approach Need for efficient mechanisms to support implementation Guidelines for reporting systems Patient empowerment and information Arising from the survey Safety culture and multidisciplinary team work, with the patient as part of the team require immediate attention

19. The lack of a safety culture (individual and institutional) The lack of communication between professionals and between professionals and patients The weak pro-active risk assessment The limitation of funds and sometimes subsequent access to technologies Common obstacles

20. PHC: QI at country level HOSPITALS: PATH project Quality & SafetyDevelopments in WHOEUROPE

21. Hospitals: PATH project: Performance assessment tool for quality improvement in hospitals • Initiated in 2003 • 51 Hospitals from 6 countries • internal quality assessment, • multidimensional perspective on hospital performance (safety is one of the dimension) • Pilot phase terminated • => demonstrates important differences in performance, including patient safety

22. Patient safety: - In-hospital mortality rates for tracer conditions: (acute myocardial infaction, community aquired pneumonia, hip replacement, stroke; hip fracture) Readmission to intensive care unit Caesarean section Pressure Ulcers [not collected in pilot] Nosocomial Infections [not collected in pilot] Staff safety: Excessive Working Hours Needle Injuries Patient and staff safety are inextricably linked. Core Safety Indicators

23. Next steps for PATH Preparation of 2nd wave of data collection in 2006 (from 51 hospitals in 6 countries to >200 hospitals in 10 countries). Technical workshop 13/14 October 2006 in Barcelona to agree on revised indicators: harmonization with other indicator sets and strengthening the patient safety component (OECD, AHRQ, SIMPATIE …)

24. Next steps for WHO EURO WHO supports patient safety initiatives WHO develop activities and a position paper on patient safety for the European region Harmonization of indicators with other international agencies is one of WHO’s aim Patient safety and quality are inextricably linked and will be addressed at Health Systems Conference 2008

25. Safety Information is on the Agenda at all levels: patient, region, country, international But not in all places and not at the same speed Which interventions to promote the safety information agenda from the Patient Perspective, the National Perspective, the Regional Perspective or the International Perspective? CONCLUSION