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?