International Perspective and Conclusion Gérard Schmets WHO 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

EU(15-prior ) average CIS(12) average Life expectancy at birth, males, Source: Health For All Database, July 2004 Life Expectancy at birth, in years

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, % of variation explained 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 Framework to Improve Safety Safety Issue: Accidental Death Exercise StewardshipFinance 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 guidelines Promote 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 PRACTICE On 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 SAFETY SURVEY

A European baseline survey 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 WHO EUROPE PHC: QI at country level HOSPITALS: PATH project

- Initiated in 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?