world health organization (who) workshop on...

Service Delivery and Safety

1 | Prasopa-Plaizier, N

World Health Organization (WHO) Workshop on Patient, Family &

Community Engagement

#qfb10



The Panel

In relation to:

• Who has paid you to give talks?• Who has paid you for advice?• Who has funded your research?• Who has paid for you to attend conferences?

• Any other interest?

All panellists declare no conflict of interest



The Panel



WHO Patient, Family and Community Engagement

2005: Engaging for patient safety (the Patients for Patient

Safety (PFPS) programme established)

2015: + Engaging for integrated, people-centred health services

2016: ++ Engaging for quality universal health coverage



Why engaged?

• Patient safety - a global health issue

• Fragmented health care and services

• Health systems unable to respond to increasing demand, rising costs, the needs of different population groups

• Inequity and Inequality

Key challenges in health care



Patient safety - a global health issue



• 400 million people lack access to one or more essential health services.

• 2.4 billion people still with no access to toilets

• 32% of total health expenditure comes from out-of-pocket payments.

• Every year 100 million are pushed into poverty and 150 million people suffer financial catastrophe

Inequity of access

(http://www.who.int/mediacentre/factsheets/fs395/en/

http://www.who.int/mediacentre/factsheets/fs395/en/



• Life expectancy –a girl born in 2012 in

Japan, life expectancy 87 years, in

Sierra Leone 46 years.

• Over 3.6 billion diagnostic procedures

using radiation performed between

1997 and 2007 (UNSCEAR, 2000; UNSCEAR,

2010) - increasing concern about

inappropriate or unjustified use of

medical radiation.

Inequality


11 | Prasopa-Plaizier, NCredits: S Syed

Universal health coverage (UHC)

UHC

Ensuring that all people can

use the promotive,

preventive, curative,

rehabilitative and palliative

health services they need, of

sufficient quality to be

effective, while also ensuring

that the use of these services

does not expose the user to

financial hardship.



People-centred and integrated health services are critical for reaching universal health coverage.

(http://www.who.int/healthsystems/topics/delivery/en/)



“All people have equal access to quality health services that

are co-produced in a way that meets their life course needs,

are coordinated across the continuum of care and are

comprehensive, safe, effective, timely, efficient and

acceptable; and all carers are motivated, skilled and operate

in a supportive environment”

The vision

Credits: N Toro & H Montenegro



Credits: N Toro & H Montenegro &



UHC & Quality Unit, WHO/SDS

Credits: Shams Syed & N Prasopa-Plaizier



UHC & Quality at WHONew WHO Unit on UHC & Quality

Within the WHO Department of Service

Delivery & Safety in the Health Systems &

Innovations Cluster

To work on three technical areas:

Area 1:

Country engagement & global frameworks

Area 2:

Health service resilience

Area 3:

Partnerships for improvement

Credits: S Syed



Global Patient, Family & Community Engagement

WHO and the Patient Care Program of the Gordon and Betty Moore Foundation collaborate to develop the WHO Framework on Patient and Family Engagement :

guide and facilitate meaningful engagement respond to WHO global policy directions on:

• Patient safety and quality Health Services• UHC Quality

• Integrated People-Centred Health Services

The Advisory Group

Sir Liam Donaldson (Chair)

Susan Baade

Dominick Frosch

Edward Kelley

Vivian Lin

Hernan Montenegro

Margaret Murphy

Nittita Prasopa-Plaizier



C – Compassion

A – Accountability

R – Respect

E – Equity



Patient…the game changer

“She went where no other lecturer had been before. She taught us about emotion, about communication and about caring for the patients and their family. She taught us what it takes to become a great doctor..”



Compassionate care:

• Positive provider-patient relationship & experience

• Better sharing of information

• More effective planning

• More efficient care delivery

• Better health outcomes

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiG5uvk6IrMAhVCG5oKHXnGALgQjRwIBw&url=http://bansalhospital.com/patients-rights-responsibilities/&psig=AFQjCNEVZiWLJDzQU2GFgQVzsM3uyV4i_g&ust=1460609515893886

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiG5uvk6IrMAhVCG5oKHXnGALgQjRwIBw&url=http://bansalhospital.com/patients-rights-responsibilities/&psig=AFQjCNEVZiWLJDzQU2GFgQVzsM3uyV4i_g&ust=1460609515893886



http://www.who.int/servicedeliverysafety/events/PHCmeeting/en/

Strong and resilient health systems.

Strong primary health care is key for achieving quality UHC

Credits: S Barkley



What is Strong PHC?

24

Credits: S Barkley


25 | Prasopa-Plaizier, NCredits: S Barkley



…human, a person…

rights, dignity, values

role, responsibility



Different needs. Reaching out. Inclusive.



The Panel

Helen HaskellCo-chair, Patients for Patient Safety Programme Advisory Group

PATIENTS FOR PATIENT SAFETY

A WHO APPROACH FOR ENGAGING AND EMPOWERING PEOPLE AND

ORGANIZATIONS

Patients for Patient Safety (PFPS)

An approach to empower and capacity build patients and families as informed and knowledgeable health-care partners

A platform to bring the patient voice to health care

A mechanism to facilitate and foster collaborations - patients, families, communities, health-care providers and policy-makers

A WHO programme

A global patient

advocate network

World Alliance for Patient Safety

2002: Resolution WHA 55.18

"…to pay the closest possible attention

to…patient safety…"

2004: World Alliance for Patient Safety

2009: WHO Patient Safety Programme

2013: Service Delivery and Safety"

Department

In honour of those who have died,

those who have been left disabled,

our loved ones today,

we will strive for excellence,

so that all people receiving health care

are as safe as possible,

as soon as possible.

This is our pledge of partnership

The London Declaration

PFPS workshop 2005, London

The patient and family are the only

people who are present throughout the

full continuum of care ... To achieve

changes with lasting impact, patients

must be at the very centre of the quest

to improve patient safety.

-Patients for Patient Safety programme

Facts do not change feelings and

feelings are what influence behavior.

The accuracy, the clarity with which

we absorb information has little effect

on us. It is how we feel about the

information that determines whether

we will use it or not.

-Vera Keane, Bulletin of Nurse Midwifery

Promoting the principles of engagement and

empowerment with key stakeholders

Countries in AFRO:

EthiopiaGhanaKenyaMalawiUgandaZambia

Countries in AMRO/PAHO:

ArgentinaCanadaChileColumbiaCosta RicaEcuadorMexicoPanamaParaguayPeruUSA

Countries in EMRO:

Egypt, Jordan, Lebanon, Morocco, Pakistan, Sudan, Yemen

Countries in EURO:

Croatia,Denmark, France, Germany, Greece, Ireland, Israel, Italy,

Countries in SEARO:

IndiaIndonesiaMaldives Nepal Sri Lanka Thailand

Countries in WPRO:

AustraliaChinaNew ZealandMalaysia

Lithuania, Norway, Poland, Russia, Slovenia, Spain, Turkey, UK, Ukraine

Global Impact

• Engage local 'leaders & stakeholders': MoH, civil society, professionals, patients, community & interest groups

• Build & strengthen national capacity for engaging and empowering people, patients, health-care providers and policy-makers

• Establish a national network of patient advocates• Empower patients, families, community, health-care professionals &

policy-makers

Patients for Patient Safety (PFPS) workshop

Photo credits: PFPS workshop in Uganda, November 2015

Engaging for effective

health systems and

services

Focus groups and discussions with

village health teams in Uganda

Shanghai International Summit for Nursing

EMRO regional workshop on capacity-building of

patient safety and health care quality

Create partnerships for sustainability

• We have

resources/tools to

support the guidance

• For instance; the PFPS

workshop guide

Collaboration: WHO Patient Safety and

Department of Reproductive Health Research

WHO MOTHER BABY 7DAY MCHECK TOOL

Why?: to empower mothers to recognize danger

signs during the first 7 days after birth and encourage

appropriate health care seeking behaviour

How?: Patients helped develop the tool – identified

issues, developed and tested messages, collaborated

with health-care providers, disseminated

PATIENT'S COMMUNICATION TOOL FOR

SURGICAL SAFETY

• Collaboration

between health-care

providers and patients

• Technical messages

drafted by health-care

providers

• Patients helped

review, comment and

refine messages

• Patients helped

disseminate the tool

For more information please visit: http://www.who.int/patientsafety/safesurgery/en/

http://www.who.int/patientsafety/safesurgery/en/

• Collaboration - doctors, pharmacists and patients

• Technical information drafted by pharmacists

• Then reviewed by doctors and patients

• Patients helped identify gaps in messages

• Patients helped refine/simplify messages – from

jargons to lay people language

• They added perspective of users of information

• Patients help with dissemination - added

credibility, encourage acceptance among patients

PATIENT'S COMMUNICATION

TOOL FOR SAFE MEDICATION

PATIENT SAFETY CURRICULUM

• Support patient safety education by creating

and disseminating curriculum resources;

• Provide a Curriculum Guide that can be easily

adapted to suit various educational needs;

• Empower health-care schools and universities

to build capacity in teaching patient safety;

• Ensure cultural sensitivity to different health

education systems;

• Raise awareness and engage commitment of

the need for patient safety teaching and learning.



The Panel

• Innovations as as every day work

• Designing together with those we

care for



Discussion


60 |

COMPASSION- DEFINITION and BLUEPRINT -

A sympathetic consciousness of others’ distress

together with a desire to alleviate it

FIRST DO NO HARM


61 |

British Medical Association: With Head, With Heart, With Hand

The good doctor treats the disease, the great doctor treats the person who

has the disease – the holistic approach

The raison d’etre of healthcare

Combining evidence based medicine with narrative based medicine

Viewing the patient as a resource with the greatest vested interest in the

outcome

Focus on Head and Skill to the detriment of the heart (compassion) and

staff and patient satisfaction

GUIDANCE and INSIGHTS


62 |

MANAGEMENT of ADVERSE EVENTS

Synchronising Culture and Expectation The David and Goliath nature of the litigation process

Preference for transparency, preventing recurrence and learning

90+% of survey respondents indicate they trust their doctor to tell the truth

A need to have compassion and empathy extended to patient, family and staffs

involved in adverse events

Disclosure ≠ BLAME

Disclosure = INTEGRITY, DEMONSTRATION OF

TRUE PROFESSIONALISM


63 |


Synchronising Culture and Expectation The David and Goliath nature of the litigation process


90+% of survey respondents indicate they trust their doctor to tell the truth

A need to have compassion and empathy extended to patient, family and staffs

involved in adverse events






Engaging is empowering…



PFPS Network Strengthen capacity,

communication, advocacy

Policy-makers Collaborate with WHO, national,

international organisations

Academic

institutions

Create and share knowledge

through research, education and

training

Health-care

providers

Facilitate patient-engagement at

hospitals and health-care

facilities

Civil society

and NGOs

Collaborate with NGOs and

professional organisations

WHO HQ

Engage, collaborate, partner, empower



Engage with us: www.who.int/patientsafety/

Email: [email protected]

Let's work together to CAREput back into health care

http://www.who.int/patientsafety/

mailto:[email protected]

COMPASSION- DEFINITION and BLUEPRINT -

A sympathetic consciousness of others’ distress

together with a desire to alleviate it

FIRST DO NO HARM

British Medical Association: With Head, With Heart, With

Hand

The good doctor treats the disease, the great doctor treats the

person who has the disease – the holistic approach

The raison d’etre of healthcare

Combining evidence based medicine with narrative based

medicine

Viewing the patient as a resource with the greatest vested

interest in the outcome

Focus on Head and Skill to the detriment of the heart

(compassion) and staff and patient satisfaction

GUIDANCE and INSIGHTS

The Effectiveness of the Storyto stimulate insight and reflective learning

“Facts do not change feelings and feelings are what influence

behaviours. The accuracy, the clarity with which we absorb information has

little effect on us; it is how we feel about the information that determines

whether we will use it or not”.- Vera Keane, 1967

Indian Saying:

Tell me a fact ...and I’ll learnTell me a truth …and I’ll believeTell me a story …and it will live in my heart forever


Synchronising Culture and Expectation

The David and Goliath nature of the litigation process


90+% of survey respondents indicate they trust their doctor to tell

the truth

A need to have compassion and empathy extended to patient,

family and staffs involved in adverse events




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