the apps approach - who · the ace approach (apps community engagement approach) has 7-steps. each...

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African Partnerships for Patient Safety (APPS)

Engaging Communities: making it real

APPS Community Engagement Implementation Pack

The APPS Approach

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Contents

Purpose and Scope 3

How can the ACE Approach integrate within 4 the APPS Programme Cycle? General Lessons on implementing ACE 5

Step 1: Know the Community 6

Step 2: Establish an Enabling Community Engagement 7 Environment Step 3: Raise Patient Safety Awareness – locally and nationally 8 Step 4: Collect Community Knowledge and Experiences 9 Step 5: Ensure Robust Communication Mechanisms 10 Step 6: Feed into Monitoring and Evaluation 11 Step 7: Develop a Community Ripple Effect 12

Annex 1: APPS 6 Step Programme Cycle and the 14

ACE Approach Visual

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Purpose and Scope

African Partnerships for Patient Safety (APPS) considers community engagement as an

important aspect of hospital patient safety improvement. This document provides APPS

hospitals with systematic assistance in developing and maintaining community engagement

mechanisms.

The ACE Approach (APPS Community Engagement Approach) has 7-steps. Each step is

considered in turn with the following information:

Summary of the ACE step

Overview of how the ACE step sits within the APPS 6-Step improvement cycle

How the step is reflected in the APPS Patient Safety Situational Analysis tool,,

outlining specific related questions

Examples of activities undertaken by current APPS Partnership Hospitals

Questions to prompt further ideas and developments to support designing and

planning community engagement activities

APPS Project Structures: Overview

Seven Steps of the ACE Approach

1. Know the Community 2. Establish an Enabling Community

Engagement Environment 3. Raise Patient Safety Awareness -

locally and nationally 4. Collect Community Knowledge and

Experiences 5. Ensure Robust Communication

Mechanisms 6. Feed into Monitoring and Evaluation 7. Develop a Community Ripple Effect

APPS 6-Step Cycle for Patient Safety Improvement

Partners work together to establish the patient safety baseline in their respective hospital using a patient safety situational analysis tool. Results of the analysis are examined to identify gaps which might contribute to patient harm and priorities for action agreed. An action plan is developed with the involvement of both partner hospitals, and action is taken to address the patient safety gaps. A review and evaluation cycle is built in.

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How the ACE Approach integrates within the APPS Cycle

As the diagram above shows, the ACE approach weaves its way through the activities

during the 6 step APPS cycle, running alongside each step of the APPS process. Some of

the same ACE activities appear in more than one step. The diagram illustrates a

mechanism to use in your planning and is not meant to represent an exclusive process.

Each step and overlap of the two processes should be treated with fluidity and flexibility,

tailored to specific circumstances and environments.

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General Lessons on Implementing ACE

Several key lessons have been shared from current APPS hospital-to-hospital partnerships

on establishing effective community engagement mechanisms to support their patient safety

efforts. These provide a basis on which to frame efforts you are planning on community

engagement within your partnership work.

1. Include community engagement from the beginning of your partnership work in

patient safety. It is ideally not an “add on” for later down the line but should be

planned and acted on from the launch of the APPS focussed partnership working.

Mobilization of communities and sensitization of partners and health care workers is

essential from the start.

2. Communities need to be empowered and understand their rights and responsibilities

so they can ‘demand’ better services and have the confidence to promote and remind

health care workers to wash their hands.

3. “Patient Guardians” have a unique role and are critical in the response to

overburdened health work force. As critical carer givers for patients in daily living

activities, they can be key partners in patient safety improvement.

4. Acknowledgement that there is a scarcity of human and financial resources for

community engagement activities making it essential to weave it into partnership

activity planning.

5. Community engagement has more momentum and is seen as strengthening the

technical elements of patient safety improvements being undertaken.

6. It is never too late. Some partnerships utilized community engagement mechanisms

after establishing a basis for patient safety in the hospital. While this was not

considered ideal, this step-wise approach worked for some partnerships.

Feedback from ministries of health from countries with an APPS partnership has also

provided some useful foundations on which Community Engagement can support on-going

patient safety work. 75% of ministries who participated in a recent survey stated that

national policy on patients’ rights and responsibilities had changed over the last two years

and 75% of them were aware of patient groups active on the national level who were

campaigning for improvements in health care quality, access to health care and changes to

national health policy. This national context provides a clear place to start, both for mapping

key players to engage with, and in terms of developing effective community engagement at

the local level building on the national frameworks and mechanisms already in place around

rights and involvement.

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STEP 1: Know the Community

*see full visual above in Annex 1.

Step Summary:

Map the local key players

Map existing organizations and mechanisms for community partnerships that could add value to the development and design of the APPS hospital partnership plan

Identify community perspectives on patient safety and medical harm

Identify the role of the family and the household in providing safe care

Things to consider:

Who are the key players in the local community and who should be involved with APPS in

order to ensure effective community involvement?

Does the hospital have any existing links with civil society and community that can be

utilized in order to better understand community perspectives on the hospital and the

safety of their care?

Examples of activity:

COU Kisiizi Hospital, Uganda undertook a mapping

exercise to establish what mechanisms already existed

in the hospital where patient safety messaging could be

included to educate the local community on the APPS

work and patient safety issues in particular. Listing all

the outreach clinics, local social groups, the reach of the

health insurance scheme run by the hospital were all

mapped as opportunities, along with the role of the

hospital within the community such as having a primary

school and church on the same site.

In Kamuzu Referral Hospital, Malawi, using the

community to connect with the district level health

institutions was critical. As a central referral hospital

they did not have the mandate to work directly with the

community or necessarily the right mechanisms. They

undertook district level health briefings on patient safety

and used structures such as disease surveillance and

cholera outbreak committees to spread patient safety

awareness and messages.

Patient Safety Situational

Analysis:

Relevant Questions

Section IV

Q10. Does the hospital have any links

with civil society and community that can

be utilized for increasing awareness of

patient safety?

Section X

Q8. Does the hospital have any

outreach programmes working in the

community?

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STEP 2: Establish an Enabling Community Engagement

Environment


Step Summary:

Create buy-in, commitment and understanding within the hospital

Facilitate and support community members to participate in meetings, consultations and reviews

Foster emergence of dynamic community leaders who can champion messages

Have clear jointly agreed vision of the engagement process and a common agenda with roles and responsibilities

Things to consider:

Are there any national patient organizations or consumer associations that would be

interested in being involved?

How can you share with other hospital leaders and staff the importance of engaging with,

talking to and valuing patients, family members and local community?

How can you support community representatives to be involved – do they need a one to

one briefings, extra support with literacy, support to attend meetings? 7


Hospital Fann, Senegal has connected with the local

community and now has two community representatives

on the APPS Advisory Board at the hospital.

In Kamuzu Referral Hospital, Malawi, two

representatives from national patient and consumer

organizations are on the APPS Board within the

hospital. They have also invited guardians to join

department meetings at regular intervals. Lessons can

flow both ways about perspectives on care. Patient

safety messages that can go home and be shared with

family and friends, for example on effective hand

washing and asking doctors questions when something

is unclear.

Patient Safety Situational Analysis:

Relevant Questions

Section IV

Q5. Are there any mechanisms in place to

sensitize health professionals on the

necessity and means through which patients

and community can be engaged on patient

safety issues?

Section X

Q1 Has the hospital involved patients and

community in priority setting, service planning

and patient safety improvement?

Q5. Does the hospital have a committee to

plan and develop partnerships between

patients/families?

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STEP 3: Raise Patient Safety Awareness – locally and nationally


Step Summary:

Feed into existing health campaigns and programmes with patient safety knowledge

Construct education and training mechanisms for patient safety awareness

Promote, advocate for and influence patient safety policy development at all levels

Use community mechanisms to promote understanding of patient safety at the grassroots.

Things to consider:

What are the key events in the coming year

where you can raise awareness of patient

safety within the community e.g. Hand

Hygiene Day (5 May), Global Handwashing

Day (15 October), Patient Solidarity Day (30

October)

Can you access local media to relay

messages that support patient safety activities

at the hospital?

How could you support local patient

champions to conduct campaigns and

education programmes on patient safety which

will in-still confidence, adherence and

sustainability of the partnership work?


In COU Kisiizi Hospital, Uganda several outreach

clinics which had been identified as relevant mechanisms

provided good awareness raising opportunities, including

groups for the elderly and providing lessons to local

primary school children on the importance of hand

washing. As a faith based hospital they also undertook

demonstrations on hand hygiene to the community through

church services. At their launch of the APPS programme a

local song and dance group created and performed a song

on the importance of hand washing and patient safety.

In Kamuzu Referral Hospital, Malawi, they undertook

a hand hygiene and infection prevention and control

awareness event at the local market, carried out

knowledge sharing on patient safety with patients, families

and guardians through morning meetings at the hospital

entrance and are collaborating with several of their clinics

on safety issues eg. Compliance to long term therapy for

HIV/Aids and diabetes clinics, antenatal education and

under 5’s clinic for the education for nutritional feeding

programme. The hospital also has a series of posters

sharing information about patients’ rights.

In Gondar University Hospital, Ethiopia, they ran a

poster campaign with local school children on hand

washing and what hand washing meant to them. The two

winning designs have now been turned into reminder

posters for health care staff, patients and families around

the hospital.


Relevant Questions

Section IV

Q2. In the last year has the hospital

participated in any community focussed

activities to raise awareness?

Q3. Are there any mechanisms within the

hospital to inform patients of their rights?

Q7. Any mechanisms for informing patients

and families about patient safety?

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Step 4: Collect Community Knowledge and Experiences


Things to consider:

How well do staff understand the perspective of patients, families and communities who

enter the hospital – fears, understanding of the system, experiences of care?

APPS can provide support in developing a set of questions to collect experiences even

when it may be sensitive or difficult.


In Gondar University Hospital, Ethiopia, with

their Hospital partner support, lead nursing staff took

time to walk through the hospital and ‘interview’

patients and families about their experiences of the

service they had received and also their thoughts on

the quality of the care they had either received or

witnessed. The experience was hugely informative

for the staff to really see things from the patient

perspective and better understand their concerns and

fears. The patients and families appreciated being

listened to and being able to speak out. The plan is to

make this a more regular activity to collect

experience and learning that can feed into APPS

planning and activity.


Relevant Questions

Section IV

Q9. Are there any mechanisms for patients

and health professionals to share ideas and

concerns?

Step Summary:

Take opportunities to collect personal experiences of medical harm, patient safety and health care experiences to support dissemination of learning

Develop case studies for education, training and initiative development

Document and capture engagement process so others can learn in the future

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STEP 5: Ensure Robust Communication Mechanisms


Step Summary:

Design and develop communication and education materials in collaboration with those for whom it is intended

Ensure effective channels of communication between community members, patients and families and the hospital

Work with media to support positive coverage of patient safety messages

Things to consider:

Invite community members and patients to be involved in creating effective materials for

communication – they’ll know what works for them best! If illiteracy is an issue can

messages be shared visually?

Do your community members have some where specific to go to voice their perspectives

and concerns? Do they know how to access that?


Hospital Fann, Senegal has worked with local radio

to open up communication with the surrounding

community on patient safety issues.

Kamuzu Referral Hospital, Malawi, has patient

suggestion boxes around the hospital so ideas can be

shared. Patients can also call the hospital leaders

directly with any concerns or complaints and the

numbers are displayed on notice boards in waiting

areas. Guardians are invited to department and ward

meetings to have open dialogue. Meetings are held in

waiting areas and by the hospital entrance to provide a

mechanism for voices to be heard.


Relevant Questions

Section IV

Q6. Is there a system to obtain patient

consent before procedures?

Section X

Q3. Has a survey been undertaken on the

way information is handled between health

professionals and patients/families?

Q4 Is there a designated member of staff

responsible for patient complaints?

Q6. Does the hospital have regular meetings

with key local community/civil society players

to interface and exchange concerns?

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STEP 6: Feed into Monitoring and Evaluation


Step Summary:

Develop mechanisms for community feedback to contribute to monitoring and evaluation of APPS activities

Use community members to monitor and evaluate and hold to account patient safety initiatives

Things to consider:

Patients and families see things that busy health care professionals may not. Think how

you could capture this to feed into the APPS evaluation and monitoring process.

A community perspective and evaluation of the APPS activities can provide valuable

perspectives to strengthen programme development.


In Kamuzu Referral Hospital, Malawi, an

evaluation mechanism includes patient guardian

contributions to hand hygiene compliance monitoring.

The intent is to include patients and their families in a

partnership to monitor and drive patient safety action.


Relevant Questions

Section X

Q2. Are there any mechanisms in use for

involving patients and community members in

feedback?

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STEP 7: Develop a Community Ripple Effect


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Step Summary:

Create a network of community stakeholders

Where possible work through formal partnerships with established community organizations to disseminate learning nationally

Ensure APPS community engagement mechanisms are in alignment with national policies and strategies on community engagement

Use APPS community engagement to enhance an integrated health care system approach from hospital to district.

Things to consider:

Is there a national patient charter that can be promoted or used as a baseline for activity?

Is there an opportunity to invite a national patient or community representative to speak at

a Hospital patient safety event?

Is there a patient or community network that can provide feedback on your APPS plan of

activities to see how they could support your efforts?


In Kamuzu Referral Hospital, Malawi the hospital

is working closely with the Consumer Association of

Malawi and the Malawi Health Equity Network. Both

have representation on the Hospital APPS Board and

have the reach of the national networks for sharing

lessons and information on patient safety. They have

also managed to use the patient safety improvement

work to connect with the district level health centres.

In Gondar University Hospital, Ethiopia the

national Patient Safety Charter is displayed at the

Hospital entrance.

In COU Kisiizi Hospital, Uganda, work with a

national patients’ rights organization and their efforts

with the Ministry of Health to create a Patient Charter

forms the basis for on-going discussions on potential

community activity to promote better quality of care

nationally. The importance of community engagement

was shared during a sensitization workshop held by the

hospital with representatives from all hospitals and

health clinics in the two neighbouring districts, who

came to learn about APPS and implementation.


Relevant Questions

Section IV

Q1. Does a Patient Safety Rights Declaration

or Charter exist?

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For further information or if you would like to share your experience of using this

resource please contact us on [email protected]

mailto:[email protected]

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