international perspective and conclusion gérard schmets who europe
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International Perspectiveand Conclusion
Gérard SchmetsWHO EUROPE
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
60
65
70
75
80
1970 1980 1990 2000 2010
EU(15-prior 1.05.2004) average
CIS(12) average
Life expectancy at birth, males, 1970-2002
Source: Health For All Database, July 2004
Life
Exp
ecta
ncy
at b
irth,
in y
ears
Of course, empoverishment explains
a big part of these results…
but not all!
Inter-country variations in levels of mortality in 67 developing
countries explained by indicators of care and context
Fuente: World Health Report 2005, pg 83,
% o
f var
iatio
n ex
plai
ned
0
10
20
60
50
40
30
70
80
90
100
Maternal Mortalityl
Neonatal Mortality
Postneonatal Mortality
Infant Mortality
Unexplained variation
Variation explained by financial inputs and responsiveness
Variation explained by human resource density
Variation explained by interaction between care and context
Variation explained by contextual factors
health has to do with:
economic development
democracy and values
health system
effectiveness
Can anything be done to accelerate health gain?
Strengthening Health System
saves lives
Stewardship (oversight)
Financing (collecting, pooling
and purchasing)
FUNCTIONS THE SYSTEM PERFORMS
Health(level and
equity)
Financial protection
and fair distribution of burden of funding
Responsiveness (to people’s non-
medical expectations)
Creating resources(investment and training)
Delivering services(provision)
Health systems framework
Performance
Health System Frameworkto Improve Safety
Safety Issue: Accidental Death
Exercise Stewardship Finance the System
Organize Service DeliveryGenerate Resources
• Evidence-based policies
• Non-punitive error reporting system
• Supportive supervision and control
• Assess cost of errors• Financial incentives
for performance according to standards
• Invest in safer care interventions
• 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
QUALITY & SAFETY:KEY ELEMENTS
In European Hospitals:
‘Every 10th patient
suffers from preventable harm’
(it is suspected this is higher at Primary Health Care level)
Identify actions that lead to objectives
National objective
Improve
patient safety
Intermediate objectives
Financing
Function
Stewardship
Service Delivery
Resource Creation
Possible reform
Monitor compliance with new guidelinesPromote non-punitive
reporting & safety culture
Renovate and equip maternity services
New GP and family nursing curricula
Computerized reminders
Introduce incentives for performance
Invest in safer care interventions
Evidence-based guidelines
Reduce accidental deaths
Improved safety in antenatal and delivery
care
Improved access to safe delivery services
Strengthen Safety Culture
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)
SITUATION IN EUROPE:WHO EURO
PATIENT SAFETYSURVEY
A European baselinesurvey on patient safety
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
Aims:
• Overall response rate: 76.9% • The first to respond: new EU
and accession countries• The lowest response rate: NIS
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
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
Quality & Safety
Developments in WHOEUROPE
• PHC: QI at country level
• HOSPITALS: PATH project
- 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
Hospitals: PATH project: Performance assessment tool for quality improvement in hospitals
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.
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 …)
Next steps for PATH
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
Next steps for WHO EURO
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?
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