Thailand Self-assessment on Patient Safety Situation: A Key Contribution to the Establishement of National Patient and Personnel (2P) Safety Policy Nareerut Pudpong, RN, MPH, PhD Patthanan Kongchum, RN (Hemodialysis) Piyawan Limpanyalert, MD, Obstertircian/ Gynecologist Healthcare Accreditation Institute (Public Organization), Thailand. E-mail: nareerut@ha.or.th 1

Outline presentation Background Objectives of Thailand self-assessment on patient safety Tool and methods Results National Patient and Personnel (2P) Policy Recommendations of priority actions Strengths and limitations of the assessment Current and next steps 2

Background (1) – What is the HAI? Healthcare Accreditation Institute (HAI), Thailand, a Public Organization established since 2009, accredited by International Society for Quality in Health Care (ISQua) Vision: “Thailand adopts standard and reliable healthcare services, with HAI as a quality culture driver (change catalyst).” Mission: To enhance, support and drive quality improvement in healthcare systems, through self-assessment, external survey, accreditation and knowledge sharing.  Clients > 1,000 public/ private hospitals in Thailand. About 350 hospitals have been visited annually for accreditation by more than 100 surveyors of HAI. 5th fl. National Health Building, Ministry of Public Health, Muang, Nonthaburi 11000 THAULAND. Tel: +66 2832 9400 Fax: +66 2832 9540 3

Background (1) – Where is Thailand? Population (2015): 69.9 million Area: 513,115 sq km (198,115 sq miles) GDP (2014): $404.8 billion, 0.9% GDP growth Life expectancy: 71 years (male), 78 years (female) Province: 77, District: 878 Hospitals (2015): 1,320 Hosp. accredited by HAI (2015): 980 (74.24%) 4

Background (3) – Southeast Asia Region (SEAR) and Patient Safety Several Regional Committee (RC) Resolutions to promote patient safety. In 2015, the Resolution SEA/RC68/R4: “Patient safety contributing to sustainable universal health coverage” were adopted. WHO South-East Asia Regional Office (SEARO) developed the Regional strategy for patient safety in the WHO South-East Asia Region (2016-2025), focusing on a system-wide approach. There are 6 Strategic Objectives (SOs), which cover complete spectrum of patient safety. 5

Background (4) – Southeast Asia Region (SEAR) and Patient Safety The starting point of the system wide approach is to understand the patient safety situation of the country. WHO-SEARO further developed the country-self assessment tool for determining current situation on patient safety in each country. Thailand was the 4th country in SEAR, following Maldives, Sri Lanka and Timor Leste, that conducted the country selfassessment. HAI is a focal point for carrying out the self-assessment on patient safety situation in Thailand, with involvement of key stakeholders, such as the Ministry of Public Health, healthcare professional councils (medical, nursing, dental, and pharmaceutical), the National Health Security Office, and the National Health Commission. 6

Objectives of Thailand Self-assessment on Patient Safety To determine the situation of patient safety in Thailand To establish the baseline information for progress monitoring on patient safety improvement To recommend effective national strategies to address the identified patient safety issues. 7

Tool and Methods (1) The country-self assessment for patient safety tool of SEAR was used for assessing patient safety in six strategic objectives (SOs): SO1: To improve structural systems to support quality and efficiency of health care and place patient safety at all healthcare levels; SO2: To assess the nature and scale of adverse events in health care and establish a system of reporting and learning; SO3: To ensure a competent and capable workforce that is aware and sensitive to patient safety; SO4: To prevent and control health care associated infections; SO5: To improve implementation of the global patient safety campaign and strengthen patient safety in all health programmes (e.g. safe surgery, safe childbirth, safe injections, medication safety…) SO6: To strengthen capacity for and promote patient safety research. 8

Tool and Methods (2) The answer to questions in the tool was divided into a scale of 0-4: 0 = not present/ initiated/planned 1 = planned and initiated but implementation is less than 25% 2 = implemented between 26-50% 3 = implemented between 51-75% 4 = fully implemented (76% implementation and over) at the national level Tool was designed in the Excel, input data were showed in the dashboard. 9

Tool and Methods (3) A self-assessment committee was formed i.e. representatives of the Ministry of Public Health (MOPH); several healthcare professional councils, such as medical, nurse, dentist, and pharmacist); and HAI. Four sub-committees were formed; experts and specialists in particular areas corresponding to six strategic objectives to comprehensively assess each individual objective. A series of consultative meetings to assess, review and decide on the scores of situation of patient safety in Thailand were carried out in a 4-month period from June to September 2016. Technical support from the WHO experts on patient safety was sought to ensure a clear understanding of the use of the tool as well as the interpretation of the results throughout the process. 10

Results 11

Summary of the results SO1: “Good” in legal and regulatory framework, accreditation and external quality assessment, and safety culture, but needed more attention in patient involvements in patient safety and care. SO2: Adverse event monitoring was “weak” area, needed to pay close attention in developing guidelines and M&E system. SO3: “Patient safety management” was “fair” and thereby a room for improvement. SO4: “Excellent” for infection prevention and control, and so required maintenance for sustainability. SO5: Overall, “excellent” level of the “safe medical care”, but safe medication was a particular area that needed more improvement. SO6: “Research capacity” was “fair” -- needed to be strengthened and more research evidence for patient and personnel safety needed to be developed. 12

National Patient and Personal (2P) Safety Policy All key stakeholders agreed to place an emphasis on personnel safety improvement in parallel with patient safety improvement. After the final assessment was done on 16 September 2016, the National Policy on Patient and Personnel (2P) Safety was formally announced to the public by H E Clinical Professor Emeritus Dr. Piyasakol Sakolsatayadorn, Minister of Public Health (MOPH). 13

Three main objectives of the 2P Safety policy: To aim at achieving the national patient and personnel safety goals with strategic movement developed by the full, active participation of all key stakeholders. To promote the development of national incidents reporting and learning system under collaboration between health personnel and all related organizations at the local, regional and national levels. To encourage the engagement of patients and population in developing safety health systems in a creative manner. Note: 15 organizations (e.g. MOPH, Health professional councils, National Health Commission, Foundation of Consumer Protection…, and HAI) signed the MOU in moving forward the 2P safety policy into actions. 14

Recommendations of priority actions (1) Questions, which received the score 1-2, were the priorities for actions that required effective national strategy, including: Establishing the National Patient Safety Coordinating Committee in support of the 2P safety policy. Increasing involvement of media and Civil Society for policy advocacy and reducing problems of patient and personnel safety. Developing the national monitoring and evaluation system for 2P safety with respect to patient and personal experience, for monitoring progress in the long run. Integrating the problems of patient and personnel safety and the effective ways to improve them into the curriculum of health professional education institutions. 15

Recommendations of priority actions (2) Providing the post-graduate and/or in-house training regarding “Training for the Trainer” to promote patient and personnel safety in health care facilities. Monitoring the compliance with the infection control (IC) guidelines of healthcare workers at all levels for sustainable practice. Strengthening quality of health service systems by providing national guidelines, and focusing on the main specific issues of concern in the country, particularly “safety medication.” Building research capacity as well as generating more research evidence to improve patient and personnel safety in the Thai health systems. 16

Strengths of the assessment The involvement of several key stakeholders, including health professional councils, research institutes, the MOPH, and the HAI. The leadership and great support from H E Minister of Public Health. The policy, which focuses on not only patient safety, but also personnel safety, appears to be a unique feature of Thailand. 17

Limitations of the assessment The tool itself is largely depending on subjective data by nature. Series of consultative meetings with experts and open-minded discussion during would help minimize bias. The possible misunderstanding of the question items in the tool and/or misinterpretation of the results, clarification by the WHO experts was also sought to reduce this bias. 18

Current and next steps Thailand is now developing: - National Strategies in moving 2P safety forward - Patient and Personnel Safety Goals - Guidelines for National Reporting and Learning System Announcement of all above mentioned on “September 17th, 2017: The Global Day of Patient Safety” Appointment of the sub-committees for implementing the National Strategies on 2P safety nationwide as well as monitoring its progress. 19

Acknowledgements H E Clinical Professor Emeritus Dr. Piyasakol Sakolsatayadorn, Minister of Public Health for his leadership in formally announcing the patient and personnel (2P) safety as a national policy. Dr. Sunil Senanayake, Regional Adviser for Health System Management and Patient Safety, WHO South-East Asia Regional Office. Dr. Nima Asgari-Jirhandeh, Public Health Administrator, WHO Country Office for Thailand. All members of the committee and sub-committees of Thailand self-assessment. All 15 organizations for their pledge to work together in promoting patient and personnel (2P) safety. Dr. Anuwat Supachutikul, CEO of HAI for his leadership and guidance. Concerned HAI officers for their support throughout the process. 20

Thank you for your attentions!! 21