International Perspective and Conclusion G

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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
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Of course, empoverishment explains a big part of
these results
but not all!
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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,
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health has to do with
health system effectiveness
economic development
democracy and values
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Can anything be done to accelerate health gain?
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Strengthening Health System saves lives
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Health systems framework
FUNCTIONS THE SYSTEM PERFORMS
Health (level and equity)
Stewardship (oversight)
Creating resources (investment and training)
Responsiveness (to peoples non-medical
expectations)
Delivering services (provision)
Financial protection and fair distribution of
burden of funding
Financing (collecting, pooling and purchasing)
Performance
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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
Organize Service Delivery
Generate Resources

• 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

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QUALITY SAFETYKEY ELEMENTS
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• In European Hospitals
• Every 10th patient
• suffers from preventable harm
• (it is suspected this is higher at Primary Health
  Care level)

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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
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IN PRACTICEOn the International Agenda

• 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)

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SITUATION IN EUROPEWHO EUROPATIENT
SAFETYSURVEY
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A European baselinesurvey on patient safety
Aims
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• Overall response rate 76.9
• The first to respond new EU and accession
  countries
• The lowest response rate NIS

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Arising from the survey

• 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

Safety culture and multidisciplinary team work,
with the patient as part of the team require
immediate attention
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Common obstacles

• 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

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Quality SafetyDevelopments in WHOEUROPE

• PHC QI at country level
• HOSPITALS PATH project

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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
• gt demonstrates important differences in
  performance, including patient safety

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Core Safety Indicators

• 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.

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Next steps for PATH
Preparation of 2nd wave of data collection in
2006 (from 51 hospitals in 6 countries to gt200
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 )
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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 WHOs
aim Patient safety and quality are inextricably
linked and will be addressed at Health Systems
Conference 2008
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CONCLUSION

• 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?