Patient Safety Research - aagbi

81 Pages·2012·0.57 MB·English

Patient Safety Research
A guide for developing training programmes
Patient Safety Research
A guide for developing training programmes
WHO Library Cataloguing-in-Publication Data
Patient safety research: a guide for developing training programmes.
1. Patient care-standards. 2. Health personnel – education.
3. Curriculum. 4. Health services research. 5. Quality of health care.
6. Manuals. I.World Health Organization.
ISBN 978 92 4 150344 0 (NLM classification: WX 167)
© World Health Organization 2012
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Foreword
Unsafe care is a global problem everywhere. WHO Member States, specialized
agencies and institutions are working hard to develop solutions that can tackle
the most pressing safety concerns. Much has been accomplished, but much
more still needs to be done. Innovations and safety practices need to be
developed and adopted by health-care staff and institutions. In many cases,
they also need to be customized to maintain their efficacy. New interventions
are also needed, and the benefits of all these efforts must be evaluated in order
to assist decision-makers in making the right choices that lead to improved
patient safety.
So, safer care needs systematic approaches and methodologies that lead
to better understanding of the nature and magnitude of safety problems
and of their contributing factors.
In 2008 WHO Patient Safety identified a set of core competencies needed
for conducting patient safety research as a basis for improvement. These
represent a recognition of the need to strengthen the health task force
internationally in order to facilitate systematic improvements in patient safety
in all parts of the world. The essence of these competencies is the science
of patient safety, the methodologies for epidemiology and health services
research and principles for knowledge translation.
How to effectively develop these competencies through tailored training
programmes is the basis of this guide. It intends to guide educators in
addressing the design and general content areas of training curricula for
postgraduate researchers and practitioners aiming to apply those concepts
in the area of patient safety.
By providing examples of learning objectives and the necessary steps for course
development, educators can choose the specific competencies that need to be
taught and the methods that best fit particular cases, based on the learner’s
profile, goals and resources.
I wholeheartedly hope that this guide will help to build the necessary capacity
for improving patient safety worldwide, especially in those countries where
it is most needed.
Dr Marie-Paule Kieny
Assistant Director-General
Innovation, Information, Evidence and Research
World Health Organization
3 Foreword
Acknowledgements
Drafting group David Bates
Sonal Arora Brigham and Women’s Hospital, Boston, USA
Imperial College, London, UK Festus Ilako
Romsai Tony Boonyasai African Medical and Research Organization
Johns Hopkins University School of Medicine, USA (AMREF), WHO, Nairobi, Kenya
Albert Wu Hillegonda Maria Dutilh Novaes
Johns Hopkins Bloomberg School of Public Health, Departamento de Medicina Preventiva FM-USP,
Baltimore, USA Sao Paulo, Brazil
Carmen Audera Jiruth Sriratanaban
Patient Safety Programme, WHO Chulalongkorn University, Bangkok, Thailand
Itziar Larizgoitia John Gosbee
Patient Safety Programme, WHO University of Michigan and Red Forest Consulting,
Ann Arbor, USA
Advisory group John Orav
Nick Sevdalis Brigham and Women’s Hospital, Boston, USA
Imperial College, London, UK Liane Ginsburg
Lilly D. Engineer York University, Toronto, Canada
Johns Hopkins Bloomberg School of Public Health, Maria Woloshynowych
Baltimore, USA Imperial College, London, UK
Anne Andermann Mark Joshi
Family Medicine Centre, St Mary’s Hospital, University of Nairobi, Nairobi, Kenya
Montreal, Canada Miguel Recio Segoviano
Charles Vincent Ministerio de Sanidad y Consumo de Espana,
Imperial College, London, UK Madrid, Spain
David Bates Narendra Arora
Brigham & Women’s Hospital, Harvard School INCLEN, New Delhi, India
of Public Health, Boston, USA Naruo Uehara
Tohoyo University School of Medicine, Miyagi-ken,
WHO Patient Safety Education Japan
and Training Working Group
Peter Norton
Ahmed Al-Mandhari University of Calgary, Calgary, Canada
Sultan Qaboos University Hospital, Muscat, Oman Peter Pronovost
Alan Pearson Johns Hopkins University School of Medicine,
Johanna Briggs Institute, Adelaide, Australia Baltimore, USA
Anne Andermann Sergio Mun~oz Navarro
Family Medicine Centre, St Mary’s Hospital, Universidad de la Frontera, Temuco, Chile
Montreal, Canada Steven Wayling
Antoine Geissbuhler WHO, Geneva, Switzerland
Hôpitaux Universitaires de Genève, Genève,
Switzerland
Patient Safety Research: A guide for developing training programmes 4
Tawfik Khoja Matthew R Hill
Health Ministers Council for Gulf Cooperation Imperial College, London, UK
Council States, Riyadh, Saudi Arabia Merrilyn Walton
Zhao Yue University of Sydney, Sydney, Australia
Peking University People’s Hospital, Peking, Mondher Letaief
People’s Republic of China University of Monastir, Monastir, Tunisia
Nantawarn Kitikannakorn
External Reviewers Naresuan University, Phitsanulok, Thailand
Annette Marshall Nancy Lowitt
Imperial College, London, UK University of Maryland School of Medicine,
Anthony McKay Baltimore, USA
Imperial College London, UK Neti Nurani
Antonio Cunha Gadjah Mada University, Yogyakarta, Indonesia
Hospital Universit_rio Clementino Fraga Filho, Nurwestu Rusetiyanti
Rio de Janeiro, Brazil Gadjah Mada University, Yogyakarta, Indonesia
Aysegul Gozu Philippe Michel
Franklin Square Hospital Center, Baltimore, USA Comité de Coordination de l’Evaluation Clinique
Benjamin Ellis et de la Qualité en Aquitaine, Bordeaux, France
WHO Patient Safety, London, UK Pierre Claver Kariyo
Bhavinder Pawar Centre Hospitalier Universitaire De Kamenge,
Imperial College, London, UK Bujumbura, Burundi
Christopher Ente Rajamohanan K.
Imperial College, London, UK Sarayu, Kallampally, Medical College, Trivandrum,
Claudia Travassos India
Fiocruz, Rio de Janeiro, Brazil Rakesh N Pillai
Cyrus Engineer INCLEN Executive Office, New Delhi, India
Johns Hopkins University, Baltimore, USA Rhona Flin
Daniel Grandt University of Aberdeen, Aberdeen, Scotland
Hospital of Saarbrücken, Saarbrücken, Germany Roger Kneebone
David E. Newman-Toker Imperial College, London, UK
Johns Hopkins University, Baltimore, USA Rona Patey
Dennis O’Leary University of Aberdeen, Aberdeen, Scotland
The Joint Commission, Oakbrook Terrace, USA Sararaks S.
Elke Streit Institute for Health Systems Research, Kuala
Imperial College, London, UK Lumpur, Malaysia
Ezequiel Garcia Elorrio Sue Evans
LatinCLEN, Buenos Aires, Argentina College Hospital Costa Mesa, Costa Mesa, USA
Girish Kumar Singh Tanya Tierney
Medical University, Lucknow, India Imperial College, London, UK
Gloria Nenita V. Velasco Tee Chin Kim
University of the Philippines College of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Manila, the Philippines Young-Mee Lee
Hutan Ashrafian Korea University, Seoul, Republic of Korea
Imperial College, London, UK
James Mwesigwa Lwanga
Imperial College, London, UK
Jan Petracek
Imperial College, London, UK
Jorge Martinez
Universidad del Salvador, Buenos Aires, Argentina
Mami Ishikuro
Tohoku University, Sendai, Japan
5 Acknowledgements
Table of Contents
1. Introduction ..................................................................................................................8
2. The global scope of patient safety............................................................................11
3. Four steps to developing patient safety curricula ..................................................14
4. The knowledge, skills and attitudes required for each competency ....................28
5. Examples of training programmes............................................................................58
Appendix1.Additional Resources: Patient Safety online introductory Course
for Patient Safety Research................................................................................................68
Appendix 2.Evaluation of training guide ........................................................................77
7 Table of Contents
1. Introduction
1.1 What is this guide? promote the expansion of training programmes
This guide is a comprehensive document that in these areas worldwide. WHO welcomes
provides guidance to educators for the further feedback from users from different parts
development of training programmes in this of the world.
important, but less well known, field of research.
This guide addresses research for change 1.2 Why is this guide needed?
or research for improvement – a form of Increasing evidence suggests that an
translational and applied research that seeks unacceptable number of patients are harmed
to improve patient safety based on sound every day in health care. Patient safety is a global
methodology. public health problem affecting countries at all
levels of development.1More knowledge and
It is based on the principle that effective better use of that knowledge are essential for
improvement requires sound local evidence improving patient safety.2However, patient safety
about the nature and extent of existing problems research is still in its infancy. New knowledge
and risks and about the possible solutions, is required to measure and understand the risks
including the systematic analysis of how specific and causes of harm and to develop solutions
interventions fit and fare within the local context. that prevent, reduce or mitigate the effects of
Therefore, instead of prescribing a single, harm. In many clinical settings worldwide, little
comprehensive curriculum, this guide seeks is known about the epidemiology of patient
to build global capacity for patient safety safety problems. Although there have been many
and translational research by facilitating attempts to introduce solutions that improve
the development of many locally-specific curricula safety, few of these interventions have been
on these topics. subjected to evaluation.3,4New and further
research is thus imperative to reduce harm and
This guide brings current concepts on curriculum improve the safety of care.
building, training and education to the field of
patient safety research. It is designed to offer Despite significant progress in some areas
practical guidance for local educators to develop of patient safety, infrastructure and funding for
their own training programmes – adapted to their research are sparse in relation to the magnitude
context-specific learning objectives. A key feature of the problem.5,6Consequently, established
of this guide is the outline of the core skill and researchers in other areas of clinical research are
knowledge-based competencies that professionals less aware of the knowledge gaps in this field,
at various levels of expertise may wish to acquire and the skills needed to meet them. This hampers
to conduct effective patient safety research and the development of the multidisciplinary research
improvement efforts. teams that are required to build the evidence
base to support safer care.
Based on extensive consultation with key
international experts in education and training, Fostering research will require significant efforts
this first edition is offered to the wider to strengthen research capacity as the
community of educators and trainers throughout underdevelopment of this field is due in part
the world as an illustration of the possible ways to the scarcity of qualified research professionals
to build training programmes for patient safety trained to conduct research in patient safety.
research and improvement, with an aim to It is also important to bear in mind that the
Patient Safety Research: A guide for developing training programmes 8
primary purpose of patient safety research is 1.4 Rationale of this guide
to produce solutions and interventions for safer The guide is based on the principle of flexibility.
care. An important function linked to the conduct It provides training programme developers with
of research relates to the translation of research a comprehensive list of core training objectives,
findings into actual solutions and improved based on a set of agreed core competencies, and
practices and policies.7It is essential to develop examples for training programmes to be selectively
professional leaders that are able to drive change chosen by educators based on their own
through measurement and research.8This is programme objectives and target audience. When
especially important in developing and transitional developing a training curriculum, the developer
countries where the need for more cost-effective will have to decide which of these competencies
and locally acceptable interventions is most most need to be taught. The selection depends on
acute.9 the level of competence that the trainees are
expected to achieve, characteristics of the trainees
This guide attempts to address this limited (i.e., previous training in patient safety, in research
capacity in patient safety research and research methodology, in epidemiology or statistics, etc.),
translation worldwide, by helping to develop and on the level of training required (from
leaders in patient safety research, implementation specialized postgraduate degree in patient safety
and change management. If leaders are armed improvement, to basic knowledge and
with the knowledge and skills to conduct and understanding of the discipline).
use relevant research, they will be better able
to influence the development of practices and Some of the learning competencies described
policies that will make care safer on a global in this guide, such as epidemiology, research
scale. methodology, statistics, etc., are common to
other general research disciplines and would be
1.3 The audience for this guide taught in other programmes. By including them
This guide is intended for course organizers, in this guide, we are by no means suggesting
trainers or faculty members who contribute these other programmes should be duplicated
towards curriculum development and the but, rather, that curriculum and training
organization of training programmes at their programme developers should be aware of the
respective institutions. These could include: training requirements of students, The message
universities/colleges/other academic institutions, given in this guide is that competency in research
hospitals or care-providing facilities, health-related methodologies, as well as in knowledge
professional bodies or associations, ministries translation, is core to the conduct of research on
of health, governmental and non-governmental patient safety, and to the application of research
organizations. The guide aims to provide findings to patient safety improvement activities.
theoretical and practical directions on the
learning objectives and the content materials. 1.5 What does this guide contain?
These learning objectives are required to help The content of the guide is organized around
researchers, health-care professionals and four major sections:
postgraduate students acquire the set of core
competencies required to conduct or participate The global scope of patient safety:This section
in research for patient safety improvement.10 defines patient safety, what the needs are for
research in patient safety, and how these needs
Students and researchers will be the ultimate vary across the globe. These concepts are not
beneficiaries of this guide since it will provide always clear given that the patient safety
them with a clear idea of the competencies perspective represents a relatively new way of
needed to be able to improve patient safety looking at health-care delivery. This is even more
through research and measurement, and evident in developing countries in spite of the fact
will give them ideas on research topics and that patient safety is believed to be a greater
information sources. problem there than in wealthier countries.11
Research priorities for patient safety, although
Our aim is that this guide will be useful to common to some extent across the globe, acquire
curriculum developers in different countries specific meaning and perspective at the local
and regions of the world. Although this level. These have been identified by experts under
initial edition is in English, if the guide proves the auspices of WHO, and are described in this
to be successful, a serious attempt will be made guide to give the reader an idea of the kind of
to make this guide available in other languages. research needed in different parts of the world,
as well as examples of research questions.
9 Introduction
A four-step guide to developing patient safety The final section of this guide provides additional
curricula12: This section outlines a logical resources to help readers generate patient safety
framework for curriculum development, curricula. It describes a variety of example training
in a manner that allows educators to develop programmes in patient safety research as well as
the training programmes required to meet the the content of an online introductory patient
needs of specific learners and their local contexts. safety course that readers may wish to incorporate
into their own curricula. The different types of
∞.First, training programme developers learners, levels of learning and level of expertise
should conduct a targeted needs assessment expected to be attained from the course are also
to identify the background, prior expertise and described in this section.
motivations of the anticipated learners, as well
as the expectations and resources available This guide ends with a questionnaire for
for putting into place the curriculum. Doing evaluating this training guide. We encourage
so will prepare curriculum developers to better users of the guide to complete and return it
meet learners’ abilities and expectations, as to WHO Patient Safety, so that we may
well as the resource constraints of a given continually refine the material in this guide for
environment. In this sub-section, readers will future users.
find concepts and tools necessary to perform
a thorough needs assessment. 1.6 What does this guide not contain?
This guide is not designed to cover very detailed
µ.Next, training programme developers curricula content. That is, it does not provide
should explicitly set goals and objectivesfor actual teaching materials. It is anticipated that
their curriculum in order to communicate what institutions and organizations will use the guide
the guide addresses and what it hopes to enable to develop a curriculum and teaching content
learners, faculties, programme funders, and relevant to their own context, in a format
other stakeholders to achieve. To help curriculum that facilitates local delivery. For additional
developers generate meaningful objectives, training materials relevant to patient safety,
this part of the guide lists the competencies readers may refer to the WHO Patient Safety
that are needed for carrying out research and website http://www.who.int/patientsafety/en/
translating its results into policies and practices
that improve patient safety.
C.Since listing goals and objectives does not
automatically produce a guide, curriculum
developers should also design a training
programme. In this sub-section, readers will find
descriptions of several training strategies as well
as a discussion on which strategies are suitable
for which learners and contexts.
D.Finally, curriculum developers should
conduct a programme evaluation, so that they
may assess the extent of their success and refine
the training programme in accordance with
quality improvement practices. In this part of the
guide, readers will find guidance on how to assess
both the learner and the teacher. Readers will also
learn how to conduct evaluations for course
planners and external stakeholders such as
accreditation bodies and standards boards.
Examples of expected knowledge, skills
and attitudes required for each competency
are listed within the section bearing this title.
The different levels of attainment, ranging
from core to advanced, are specified within each
competency area.
Patient Safety Research: A guide for developing training programmes 10