WHO Global Patient Safety Consultation Dr Jorge César

WHO Global Patient Safety Consultation Dr. Jorge César Martínez Emeritus Professor Institute of Safety and Quality in Health Sciences del Salvador University Buenos Aires - Argentina

TRAINING THE NEXT GENERATION PATIENT SAFETY CURRICULUM GUIDE MULTIPROFESSIONAL EDITION

First global release in November 2011

Why do we need education in patient safety? ◘ ◘ Fundamental patient safety practices are far from universally applied in health care delivery Current education in patient safety is fragmented and segregated Governance and accountability for education is complex and ill-defined There are few, if any, examples of comprehensive sustainable education programs

CHALLENGES: PATIENT SAFETY EDUCATION 1 General: -Overcrowded curricula -PS not integrated into curricula & provides significant challenge -Mismatch: HCP knowledge to PS competencies + skills 2 Educators: educators have knowledge/capacity to teach PS - Not all - Educators are not familiar with the literature and unsure how to integrate patient safety in curricula Unsure how to teach PS 3 Teachings: - Poor teamwork because no inter-disciplinary training - Gender stratification of professional groups + status - Narrow clinical training without and understanding on safety - Where there is, ps education to senior students / not early years.

PILOT STUDY FOR WHO PATIENT SAFETY CURRICULUM GUIDE FOR MEDICAL SCHOOLS n n n n n School of Medicine, del Salvador University, Buenos Aires, Argentina Sydney Medical School, Australia Maulana Azad Medical College, New Delhi, India Sackler Faculty of Medicine, Tel-Aviv University, Israel Patan Academy of Health Science, Kathmandu, Nepal College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Faculty of Medicine, University of Manitoba, Winnipeg, Canada University of Aberdeen Medical School, United Kingdom School of Medicine, Cardiff University, United Kingdom

WHO Patient Safety Curriculum Guide for Medical Schools PROPOSAL GOALS - PHILOSOPHY Key aims: n To prepare medical students for safe practice in the workforce n To inform medical schools of the key topics in patient safety n To enhance patient safety as a theme throughout the medical curriculum n To provide a comprehensive curriculum to assist teaching and integrating patient safety learning n To further develop capacity for patient safety educators in medical schools n Promote moving beyond blame (adverse events). n Safety culture instead of blame culture.

TOPICS INCLUDED Topic 1: What is Patient Safety Concepts highlighted n Why it’s so relevant. n Patient Safety does not involve financial resources only rather they involve professionals’ commitment to practice Safety. Teaching strategies: n Introduction during Educational Lectures n An interactive /didactic session using video clip of speeches that have been made by patient safety leaders. n At the Hospital: Spend a day with another health professional (nurse) identifying the main role and functions.

Topic 2: Apply human factors thinking to the work environment Concepts to be highlighted Concepts highlighted n To understand the main role of human beings relationship between them and with the System. Teaching strategies: n 1) Introduction during Educational Lectures using interaction and discussion case study n 2) Practical exercises on good and bad examples of human factors principles. Intensive Care Unit- Delivery Room. Out patient-Department.

Topic 3: Understanding Systems Concepts highlighted n Changing the Doctor’s focus about risk from side effect and complications only n to apply the same reasoning to the treatment being provided by the people and the system. n What is high reliability organization. Teaching strategies: n Lecture on System and Complexity (Introduction). n Follow a Patient from the time they enter the service to the time they are discharged. (From the System point of view).

Topic 4: Being an effective team player Concepts highlighted n The challenge is not whether we will deliver care in teams but rather how well we will deliver care in teams. n Understand what is it to be an effective team player n Include the patient in the TEAM n GOOD COMMUNICATION as the main tool. Teaching strategies: n n Introduction during Educational Lectures Participate in a Perinatal Care Team discussion. Chronic patient follow up team meeting at the Maternity Hospital (interprofessional participation). Reflective exercises at the last week.

Topic 5: Understanding and learning from errors. Concepts to be highlighted Concepts highlighted n Errors occur by doing the wrong thing or by failing to do the right thing. n Learn from errors n Tips to limit potential errors. Individual factors and situations (fatigue-stress-language-illness- attitudes, etc. ) n What is a root cause analysis Teaching strategies: n n n - Introduction during Educational Lectures Interactive/Didactic lecture based on case study. Group Discussion based on Students Journal about observed error and recommendations.

Topic 6: Understanding and managing clinical risk. Concepts to be highlighted Concepts highlighted n The role of complaints in improving care n Principles of risk management programs to reduce adverse events and improve human performance. n The educational discussion instead of attributing blame Teaching strategies: n Introduction during Educational Lectures n Interactive/Didactic using case study.

Topic 7: Introduction to quality improvement methods Concepts highlighted n The problems in health system are affected by the process of care and involve people who are treating and caring for patients that are not considered by evidence base medicine and randomized control trials. n What is Science of improvement n All quality improvement methods rely on measurement. Teaching strategies: n Introduction during Educational Lectures n Interactive/Didactic Lecture

Topic 8: Engaging with patients and carers Concepts highlighted n Understanding doctor-patient communication techniques and what a patient should know about his/her care. Teaching strategies: n Introduction during Educational Lectures n An Interactive/Didactic lecture case study n Write a letter of apology related one case study or real experience. n Follow a Patient from the time they enter the service to the time they are discharged. (From the patient point of view).

Topic 9: Minimizing infection through improved infection control Concepts highlighted n Clean hands are safer hands n Main causes and types of infections n Practice universal precautions Teaching strategies: n Introduction during Educational Lectures n Interactive/Didactic lecture n Exercises: While allocated to a clinical environment.

Topic 10: Patient Safety and innovative procedures Concepts highlighted n The main causes of adverse events in surgical care n The transcendental role of the guidelines protocols and communication Teaching strategies: n Introduction during Educational Lectures n Interactive/Didactic lecture using a case study n Practical exercises while students are assigned to a surgical ward n Observe and record the activities undertaken and then a small group discussion take place.

Topic 11: Improving medication safety Concepts highlighted n Why this issue is so important n The main steps in using medication n Sources of error. Teaching strategies: n Introduction during Educational Lectures n Practical Workshops: prescribing and doing calculation n Interview a nurse- interview a doctor. Work related tasks in the clinical environment.

Concepts specially highlighted n n n How to face the old culture without confronting but in a mindfully way. Incorporate the concept to practice safe health care even when those around them do not. Understand Swiss Cheese Model to explain how faults in the different layers of the System can lead to accidentsmistakes-adverse events. Being an effective team member means learning how to substitute roles and appreciate others perspectives Relationship with patients implies relate and communicate with them as a unique human being.

CURRICULUM DELIVER Lectures n On line activities n Clinical placement (beside the bed) n Round session (problem base learning) n On the ward activities n

INTER-DISCIPLINARY TRAINING § Multi-professional perspective § Encourages inter-disciplinary learning § Suggests ways for joint learning § Prepares students and hc providers on being team members and effective clinical communication § Recommends on how to operate in a culture of no-blame but being accountable § Use case studies from multiprofessional teams as a tool for interdisciplinary learning

How to approach patient safety teaching n Use a range of teaching methods: integration into curriculum – PBL – Simulated based learning ( low & high fidelity) – Lecture based teaching (interactive/didactic) – Mentoring and coaching – Student initiated learning (prescribed ward activities) – Small group discussion – On line learning

Enhancing medical training through simulation

Q 1 What knowledge, skills and behaviours are necessary for safe practice?

New knowledge & skills required Partnerships with patients & carers Teamwork Risk communication Competent clinicians Patient centred care Deliver patient centred care Active member of multidisciplinary teams Report and learn from errors Data collection Apply evidenced based health care Adverse events Ethical practice Professional responsibility Use quality improvement approaches Professional accountability Use information technology

WHO Patient Safety Curriculum Guide Contents of Part A: Teacher’s Guide Ø Ø Ø Rationale for the topics Aims of the guide Implementing the guide How to integrate patient safety into your curriculum Educational principles essential for patient safety teaching & learning How to assess patient safety Ø Ø How to evaluate patient safety curriculum Web based tools and resources Activities to assist patient safety understanding How to foster & engage in a transnational approach to patient safety

WHO Patient Safety Curriculum Guide Part B: The Topics in the curriculum Ø Ø Ø What is patient safety? Ø What is human factors Ø engineering? Understanding systems Ø and the impact of complexity on patient Ø care Being an effective team Ø player Understanding and Ø learning from errors How to manage clinical risk Methods for quality improvement Engaging with patients and carers Minimising infection through improved Infection control Reducing risks associated with Invasive procedures Improving medication safety

How is curriculum delivered? Simulation learning/skill laboratories Lectures Problem-based learning ( PBL) Clinical placements Small group tutorial teaching Online activities On the ward activities 30

EVALUATIONCONCLUSIONS n n n WHO Patient Safety Curriculum Guide can support the introduction of patient safety teaching local examples should be used to illustrate patient safety teaching Should be highlighted the conditions and time required to successfully introduce patient safety teaching Students improved knowledge of patient safety issues Attitudes and Intentions become more positive. The longer term outcomes in the healthcare workplace are required to be known and shared.