Quality (143) Lessons from the 37th International Society for Quality in Health Care Conference, 8-11 July (2)

16 July, 2021

The second day of the conference appeared to be centered around safety. [*see note below]

Pascale Carayon talked about “How to support the work of care teams? A human factors and systems engineering perspective to address the global quality chasm”. We discussed how members of the care team, including patients, care partners, clinicians, and other health care professionals, often experience challenges in doing their work and how those challenges can result in patient safety issues, frustration, stress, and other negative outcomes, therefore contributing to the global quality chasm. She mentioned that “Systemic conditions – such as fragmentation, mal-aligned payments, poor training, unreliable supply chains, burdensome rules, inadequate information flows, lack of useful data, corruption, and fear – prevent the most willing workforce from carrying out its daily tasks successfully and contributing to the success of the whole system. As a result, patients suffer needlessly; communities squander scarce resources, and the workforce itself becomes frustrated and exhausted as a part of the ill-functioning system”.

SEIPS (Systems Engineering Initiative for Patient Safety) model can be used to analyze and improve work systems and care processes along the patient journey. SEIPS proposes that technology and tools, tasks, persons, organizations, the physical environment, and external environments form the work systems. These systems in turn create the structures which determine patient, employee and organizational outcomes.

The WHO Global Patient Safety Network team presented “Towards Eliminating Avoidable Harm in Health Care”. It featured representatives of the government from Oman and Kenya and representatives of the patients' population. The “Global action on patient safety” started in 2019 following the adoption of the World Health Assembly (WHA) 72.6 resolution on the urgent need to reduce patient harm in health care systems around the world.

A handbook, “Global Patient Safety Action Plan 2021-2030”, has just been endorsed at the last WHA in May 2021 and will guide implementation till 2031.

The action plan is predicated on a framework that includes seven strategic objectives which can be achieved through 35 specific strategies. The strategies are:

1. Making zero avoidable harm to patients a state of mind and a rule of engagement in the planning and delivery of healthcare everywhere

2. Build high-reliability health systems and health organizations that protect patients daily from harm

3. Assure the safety of every clinical process

4. Engage and empower patients and families to help and support the journey to safer healthcare

5. Inspire, educate, skill, and protect health workers to contribute to the design and delivery of safe care systems

6. Ensure a constant flow of information and knowledge to drive the mitigation of risk, a reduction in levels of avoidable harm, and improvements in the safety of care

7. Develop and sustain multisectoral and multinational synergy, partnership, and solidarity to improve patient safety and quality of care

Over the past few months, I have had to engage some experts in talking about implementation science and improvement science. We agreed that why there seems to be significant overlap, they are quite different. I was happy to see the discussion coming up at the conference when we discussed “are the fields of improvement and Implementation Science converging?” Key similarities and differences between the two fields were highlighted.

Possibly the biggest takehome from the session was the realization that there has been a lack of collaboration between Improvement Science and Implementation Science over time which has hampered the flow of knowledge from research into practice. The team also demonstrated how both sciences have been applied to implement and improve large-scale projects.

The final key lesson I will be sharing for day 2 is on “co-production”. I have been involved in a co-production of care group since April 2020, yet it was another beautiful session with Boel Andersson-Gare, Glyn Elwyn, Valerie James & Sylvie Mantis. They defined co-production as “an approach where clinicians and patients make decisions together, using the best available evidence about the likely benefits and harms of each option, and where people are supported to arrive at informed preferences”. It comprises an intertwining of the patient, the system, science-informed practice, and the professionals. The willingness for both parties to be “vulnerable” was emphasized. Three key questions “patients” and care providers should consider asking themselves after an appointment are:

1. How much effort was made to help you understand your health issues?

2. How much effort was made to listen to the things that matter most to you about your health issues?

3. How much effort was made to include what matters most to you in choosing what to do next?

I did enjoy every bit of it and will be going back to revisit some sessions and watch the videos of those that I missed. I hope you find these summaries useful too.

*Balogun Stephen Taiye* MBBS, MPH, CSSGB, SMC, PMP, FISQua

*ISQua Expert, ISQua Ambassador, Lucian Leape Patient Safety Scholar, WHO Global Patient Safety Network (GSPN) Member*

HIFA profile: Balogun Stephen Taiye is a Medical Officer/Quality Improvement Team Leader at the Olanrewaju Hospital in Nigeria. He is also currently a post-graduate student of Public Health and Business Administration. Professional interests: patient safety, healthcare quality improvement, reproducible research, data collection and analysis. He is a HIFA Country Representative for Nigeria and was awarded HIFA Country Representative of the Year 2016.

www.hifa.org/support/members/balogun-stephen

www.hifa.org/people/country-representatives/map

Email: stbalo2002 AT gmail.com

[*Note from HIFA moderator (Neil PW): Thank you Stephen for volunteering to represent HIFA for this important event, and for your comprehensive and valuable observations.]