Fifth Hospital Quality and Patient Safety Management Course, Saitama, Japan, 12-16 March 2018 : meeting report

12–16 March 2018 Saitama, Japan Meeting Report FIFTH HOSPITAL QUALITY AND PATIENT SAFETY MANAGEMENT COURSE Fi fth H os pi ta l Q ua lit y an d Pa tie nt S af et y M an ag em en t C ou rs e 12 –1 6 M ar ch 2 01 8 Sa ita m a, Ja pa n WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC RS/2018/GE/09(JPN) English only MEETING REPORT FIFTH HOSPITAL QUALITY AND PATIENT SAFETY MANAGEMENT COURSE Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC NATIONAL INSTITUTE OF PUBLIC HEALTH Saitama, Japan 12–16 March 2018 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines June 2018 NOTE The views expressed in this report are those of the participants of the Fifth Hospital Quality and Patient Safety Management Course and do not necessarily reflect the policies of the conveners. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Fifth Hospital Quality and Patient Safety Management Course in Saitama, Japan from 12 to 16 March 2018. CONTENTS SUMMARY ........................................................................................................................................... 1 1. INTRODUCTION .............................................................................................................................. 2 1.1 Background ............................................................................................................................. 2 1.2 Overview of the course ............................................................................................................ 2 2. PROCEEDINGS................................................................................................................................. 3 2.1 Role of hospitals in the health system ...................................................................................... 3 2.2 Improving quality and safety of service delivery in hospitals ................................................... 4 2.3 Adapting and applying concepts, practices and tools for quality and safety improvement ......... 9 2.4 Hospital quality and patient safety management network ....................................................... 14 3. CONCLUSIONS AND RECOMMENDATIONS ............................................................................. 15 3.1 Conclusions........................................................................................................................... 15 3.2 Recommendations ................................................................................................................. 16 3.2.1 Recommendations for Member States ................................................................................ 16 3.2.2 Recommendations for WHO .............................................................................................. 16 ANNEXES ........................................................................................................................................... 18 Annex 1. List of participants, temporary advisers, observers, Secretariat and resource persons Annex 2. Programme of activities Annex 3. Opening remarks of Dr Shin Young-soo, WHO Regional Director for the Western Pacific Annex 4. The WHO IPC Global Unit Patient safety / Hospital – standards / Health services / Hospital administration 1 SUMMARY The WHO Regional Office for the Western Pacific helps Member States improve the quality, safety and patient-centredness of health services, through policy dialogue, technical support and capacity- building, including on hospital quality and safety management. Since 2014, the Regional Office has organized the Hospital Quality and Safety Management Course yearly in Japan, in collaboration with the National Institute of Public Health (NIPH), a WHO Collaborating Centre. Over the past five years, the course has trained about 60 health professionals working in patient safety and hospital quality across the Region, who have since worked to build capacity in their countries and can potentially collaborate to build national networks to facilitate hospital quality and patient safety initiatives at national and regional levels. For the Fifth Hospital Quality and Patient Safety Management Course, held on 12–16 March 2018, in Saitama, Japan, 16 senior hospital managers and officials with responsibilities relating to hospital quality, patient safety and/or infection prevention and control (IPC) attended. They came from Cambodia (4), the Lao People’s Democratic Republic (3), Mongolia (4), the Philippines (1) and Viet Nam (4). The course built upon the participants’ knowledge and practical skills to identify, adapt and apply concepts, practices and tools for quality and safety improvement in the hospital setting and encouraged them to develop a national hospital quality and safety management network and a mechanism for peer support and knowledge sharing. Key recommendations for further actions included the following: • to develop national health-care quality and patient safety management networks comprising previous course participants and other relevant health policy-makers and professionals; • to document, share and scale up good practices in hospital management, patient safety and hospital quality improvement; • to implement initiatives in their respective country in line with the action plan that participants developed during the course; and • to evaluate the impact of the hospital quality and patient safety management courses to understand which areas of knowledge and skills were more useful, how they were used, whether and how action plans developed during the courses were implemented, and the support needed for effective implementation. The course benefited from a broad-base of additional expertise from the Japan Council for Quality Health Care, St. Luke’s International Hospital, Tokyo Medical and Dental University, the Malaysian Society for Quality in Health, the Singapore Ministry of Health, and the National Center for Global Health and Medicine, Japan (NCGM). Two staff from WHO headquarters participated in the first two days of the course. Site visits to the NCGM Center Hospital and Shinkatsushika Hospital were conducted for participants to learn about the good hospital quality and patient safety practices of these two hospitals in Japan. 2 1. INTRODUCTION 1.1 Background Quality is a key attribute of high-performing health systems, which is a foundation for progress towards universal health coverage (UHC). The World Health Organization (WHO) Regional Office for the Western Pacific supports Member States to improve the quality, safety and patient-centredness of services, including in hospitals, by convening policy dialogues, strengthening system and health professionals’ capacity, and supporting activities at the country level. Since 2014, the Hospital Quality and Safety Management Course has been organized yearly to strengthen hospital managers’ capacity to improve patient safety and quality of hospital care. The fifth course built on the strengths of previous courses and responded to feedback from past participants and suggestions of current participants. From its inception, the National Institute of Public Health (NIPH) has been the main partner hosting the course at its premise in Saitama, Japan. From 2016, the National Center for Global Health and Medicine, Japan (NCGM) has also become a key partner, hosting some part of the course at its premise. This year, the course also benefited from St. Luke’s International Hospital, a WHO collaborating centre, and a range of additional expertise, including from the Japan Council for Quality Health Care, Tokyo Medical and Dental University, the Malaysian Society for Quality in Health and the Singapore Ministry of Health. Two staff from WHO headquarters also participated in the first two days of the course. Site visits were organized to two hospitals: NCGM Center Hospital and Shinkatsushika Hospital. The Fifth Hospital Quality and Patient Safety Management Course, held on 12–16 March 2018, was attended by 16 participants – from Cambodia (4), Lao People’s Democratic Republic (3), Mongolia (4), the Philippines (1) and Viet Nam (4). They included senior managers from national and province- level hospitals and officials with responsibilities relating to hospital quality improvement and patient safety. The list of participants is available in Annex 1. 1.2 Overview of the course The course was conducted over five days, employing an adult learning approach, comprising a combination of: presentations of key concepts, principles and evidence; a participatory workshop to discuss ideas; and observation of practices in the hospital setting. Key technical contents of the course included creating an enabling regulatory environment (external evaluation including health-care accreditation) and infection prevention and control, in addition to core subjects on hospital quality and patient safety. Course facilitators, who were representatives from WHO and NIPH, temporary advisers and resource persons, introduced key concepts and ideas for discussion and facilitated participatory activities such as group discussions, experience sharing, group work, learning simulations and field visits to two hospitals. Annex 2 provides more details on the sessions and programme of activities. The course covered the following key topics: • Sustainable Development Goals (SDGs) and UHC – equity and quality • Role of the hospital in health systems • Health-care quality and patient safety • People-centred health services and patient, family and community engagement 3 • Infection prevention and control, antimicrobial resistance (AMR), and water, sanitation and hygiene (WASH) • Health-care accreditation and health-care quality • Redesigning systems for quality and people-centred services (simulation on older people’s experience, reorienting services to meet the needs of patients) • Medication safety • Leadership and hospital performance • Outbreak investigation and response • Using information and feedback from patients and the community for improvement • Strengthening hospital management to improve quality and patient safety • Practical exercise on developing an action plan for strengthening hospital management for quality and patient safety 2. PROCEEDINGS 2.1 Role of hospitals in the health system The course started with an overview of the SDGs and UHC as an overarching goal for health-care quality improvement. Nine of the 17 SDGs are related to health, with SDG 3 (to ensure healthy lives and promote well-being for all people at all ages) specifically focusing on health. UHC is both a goal and target of the SDGs. To achieve UHC, hospitals must be able to provide safe and quality health services to enable healthy lives and promote the well-being of the population. Hospitals play a key role in health systems, providing the population with emergency care and specialized health services. Hospital leaders and managers have a mandate to provide adequate infrastructure, develop and maintain a sufficient number of qualified and skilled health workforce that corresponds to the population needs of services and in line with national health workforce plan and ensure safe care and services. These directly contribute to improving the health system at large. The role of hospital leaders and managers was discussed as a group activity and the participants shared their perspective on the difference between a hospital leader and a hospital manager (Table 1). Table 1. Differences between a hospital leader and manager as shared by participants Leader Manager • Has clear vision and communicate it with people to build consensus and partnership • Builds common goals to which people drive their efforts • Inspires people and motivate them to achieve their goals • Challenges the status quo and think outside the box • Open to innovation and possibilities • Shares information – transparency • “Do the right thing” • Task-orientated; provides concrete direction and detailed instructions on a task • Works to keep projects on track and time- bound • Works within the scope of the project to produce optimal results • Provides practical guidance for addressing challenges and applying practical solutions • Focuses on processes and outputs • “Do things right” 4 Health-care professionals may play multiple roles at any given time. Sometimes, they are expected to play the role of leader and manager concurrently. Many of the course participants have dual roles as a hospital leader and a policy-maker in the health ministry, either through concurrent positions (i.e. primary and secondary appointment) or at different times through rotation of postings. The participants said that hospital leaders have to be visionary, make strategic plans and lead by example. Hospital leaders can play a transformative role in improving health service delivery to be more integrated and people-centred. Dr Tomoko Kamei shared how leaders in St. Luke’s International Hospital and International University introduced a people-centred health-care framework. The framework is premised upon close partnership between health-care providers and the community. 5SDr Kamei emphasized that mutual respect and understanding, shared decision-making, and the concept of learning and overcoming challenges collaboratively are key attributes of St Luke’s International Hospital’s people-centred care approach. She shared several practical examples of people-centred programmes that have been successfully implemented and stressed that these have increased the quality of life (QoL) scores for their elderly patients. Dr Clive Tan shared Singapore’s experiences in developing integrated and people-centred care. Hospital leaders need to work closely with policy-makers to transform the way health services are designed and delivered, in a manner that is integrated, people-centred and sustainable. To address care fragmentation, hospitals, community care services and primary care clinics have been placed under a common governance structure, termed regional health system, where resources, personnel and administrative support can be shared so as to be more efficient. Within the regional health system, clinical care processes can be streamlined, cross-institution protocols can be developed together and monitored, and bundled payments can be introduced for patient care that is delivered by different providers within the group. The care for elderly patients with multiple medical conditions and poor social support were used as examples to illustrate how the National Healthcare Group successfully redesigned the care processes to include home medical and nursing care support. The processes foster partnerships with social care agencies to help ensure these elderly have healthy meals at home and are not socially isolated. These initiatives have led to a reduction in hospital admission rates and better quality of life for these patients and reduced costs to the hospitals. The participants recognized that hospitals play an important and often leading role in the health system, because of their size, expertise and better resources. Hospitals need to lead by example to strengthen the system, improve patient care, and transform services to be more people-centred and engage people. 2.2 Improving quality and safety of service delivery in hospitals As part of their preparation before coming to the course, participants were connected to former course participants in their respective country – that is, those who participated in the previous courses between 2014 and 2017. They were encouraged to seek information on whether those past participants were still working in the areas of patient safety and hospital quality, how they used the knowledge and skills learnt from the course, and which areas of knowledge and skills they found most useful. The participants were only able to receive feedback from those former participants who were still working in these areas as they recognized them by names. They did not have sufficient information to comment on which knowledge and skills were most useful and how they were used. It was suggested that an in-country review by WHO would be more systematic and objective. 5 As part of their preparation, the participants also shared what they expected to learn from the course. Overall, they desired to gain knowledge and skills to improve patient safety and quality of health services in their respective hospital. The following is a summary of their expectations from the course: • New tools: New concepts, ideas and practical examples for quality improvement in the hospital setting – from the course faculty, facilitators and fellow participants from other countries. • Infection prevention and control (IPC): New developments, tools and practical examples for successful implementation of IPC programmes and the reduction of health care-associated infections (HAIs) in hospitals. • Surgical site infections (SSIs): Experiences and lessons learnt from hospitals that have successfully implemented the Safe Surgery checklist and reduced surgery-related infections. • Quality improvement tools: Examples of how quality improvement tools, such as 5S and Kaizen (continuous improvement), 1 have been used in hospitals and that led to good outcomes. • Frameworks, experiences and practical actions that hospitals can take to improve engagement with patients and families. • Knowledge and concepts that can be shared to strengthen hospital leaders and managers. • Knowledge and practical examples of how to improve patient safety culture, incident reporting and quality improvement in hospitals. 2.2.1 Priority-setting for action plan Priority-setting and developing strategies and plans are key responsibilities of hospital leaders. Facilitated group work was organized every day to enable the participants to practise their leadership skills in identifying issues, setting priorities and developing plans for action to address them. On the first day, participants were asked to identify issues and propose solutions relevant to the context of their hospital that they would implement upon returning home. The information formed the baseline of an action plan, on which they built as the course progressed. Table 2 summarizes key priorities and proposed actions by the participants on the first day of the course. 1 5S refers to Japanese words: seiri, seiton, seiso, seiketsu and shitsuke – or sort, set in order, shine, standardize and sustain in English. It is a method developed in Japan to organize a workplace for efficiency and effectiveness. In health care, the 5S method has been used to improve the physical environment for quality improvement and patient safety, for example effective and efficient storage of look-alike medicines help reduce medication errors caused by wrong medicines or wrong doses. 6 Table 2. Key priorities and proposed action by country Country Issue Priority Cambodia • Safety of surgical care • Poor hand hygiene practice • Waste management & environment cleaning • Irrational use of antibiotics • IPC • Patient dissatisfaction – due to long waiting • Staff lack education opportunities and have limited quality improvement capacity • Improve IPC – waste management, cleanliness of the hospital environment • Monitor quality of surgical care • Improve patient satisfaction – reduce waiting time • Use patient experiences for quality improvement – develop tools for feedback from patients and health providers • Improve hospital culture and capacity for improvement Lao People’s Democratic Republic • Hospital quality policy – no specific unit responsible for quality improvement and control • Unclear staff roles and responsibilities (or staff are not clear of their role), creating some conflicts or duplication of work between staff • Patient dissatisfaction – poor communication of staff when interacting with patients; “staff are rude to patients” • Waste management – unclean hospital environment, poor IPC, unsafe behaviour of health providers • Develop clear roles and responsibilities of staff in different positions; encourage them to follow hospital policy in quality improvement; and stimulate IPC team to implement staff training • Conduct staff training on communication and friendly behaviour towards patients • Establish proper incineration facility Mongolia • HAIs – high infection rates due to poor environment, lack of knowledge to implement and guidelines for adherence • Patient dissatisfaction/poor patient experiences – long waiting time for certain clinical services • Medication safety – lack of guidelines for rational use of antibiotics • Access to service – for people with certain needs (e.g. persons with disabilities, people living in rural areas) • Reduce HAIs – IPC, develop measures, indicators and guidelines for implementation • AMR – guidelines for rational use of antibiotics • Improve patient satisfaction/ experiences by addressing waiting time issues • New modality of services, such as outreach services Philippines • Patient falls in the hospital • Under-reporting of adverse events • Identify high-risk patient group in advance • Improve incident reporting by raising awareness of staff on the importance of reporting patient safety incidents 7 2.2.2 Health-care accreditation and quality improvement There is a spectrum of measures for improving quality in hospitals and health services. External evaluation is one such measure. It includes licensing, which is considered the basic “minimum standard” required by regulators to ensure safety. Accreditation entails using a higher set of standards to encourage performance and improve quality. Another form of external evaluation used to improve quality includes certification and awards that formally recognize expertise and/or qualifications. Dr Kadar Marikar explained the importance of quality in attaining high-performing health systems. Quality can be considered in three domains: • Technical quality, i.e. clinical effectiveness • Quality of amenities and facilities, e.g. medical supplies and patient’s food • Quality of services, i.e. interpersonal quality or how the services were delivered to patients, such as patient services, communication. Dr Marikar also presented the Donabedian concept of quality as a practical way to formulate plans for improving health-care quality. To achieve quality in health systems, policy-makers and hospital leaders need to put in place: • right structures – including human resources, roles delineation and skill mixes; • appropriate policies, processes and procedures; and • measures to monitor performance and evaluate outcomes. Mr Jimbo Katsuya from the Japan Council for Quality Health Care (JQ) shared on the Japanese hospital accreditation system and standards. In Japan, hospital accreditation is voluntary and is not tied to insurance payments. Typically, accreditation status is valid for five years. There are many small-scale private hospitals that are not accredited due to high costs associated with accreditation. Dr Marikar commented that typically fees are higher for accreditation by international health-care accreditation agencies compared with national accreditation bodies. It was this high cost issue charged by international accreditation bodies that motivated countries like Japan, Malaysia and Thailand to develop their own health-care accreditation system and standards. These national accreditation bodies are accredited by the International Society for Quality in Healthcare (ISQua), which is an umbrella global health accreditation body. International accreditation agencies are also accredited by ISQua. Participants from Mongolia and Viet Nam expressed interest in developing their own national hospital accreditation system and standards, citing the high cost barriers in obtaining accreditation from international bodies. They requested WHO to provide more information and support on this issue. 2.2.3 Infection prevention and control IPC is an important aspect of hospital quality and patient safety. IPC is a practical, evidence-based approach designed to prevent harm caused by avoidable infections. IPC prevents HAIs, reduces the spread of AMR, and supports high-quality, integrated, people-centred health services. It is a key Viet Nam • HAIs – challenges with treating pneumonia and SSIs • Inappropriate use of antibiotics • Patient safety incidents (adverse events) • Improve IPC practice – staff training/education on IPC • Measures to reduce patient safety incidents and mitigate impact 8 strategy for dealing with public health threats of international concern (on the global health security agenda and the International Health Regulations). Dr Benedetta Allegranzi and Dr Jolanta Griskeviciene provided an overview of WHO guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health-care facilities and guidelines on the core components of IPC programmes at the national and facility level2 (Box 1). These guidelines form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, combat AMR and improve the overall quality of health-care delivery. The guidelines should be adapted to local context. Implementing IPC core components requires human resources, budgets, infrastructure and qualified IPC professionals. The WHO framework for implementing IPC interventions at the facility level includes five steps to be undertaken sequentially: Step 1: facility preparedness – readiness for action Step 2: baseline evaluation – establishing knowledge of the current situation Step 3: implementation – introducing the improvement activities Step 4: follow-up evaluation – evaluating the implementation impact Step 5: ongoing planning and review cycle – developing a plan for the next five years (minimum) Practically, at the facility level, IPC is about ensuring IPC measures are implemented and monitored (Box 2). Leadership is necessary to provide an official mandate for IPC, drive culture change, and ensure human and financial resources. Leadership is crucial to influence, motivate and enable health professionals, including doctors, nurses and managers among others, to implement IPC measures and change behaviours. Box 1. Core components of IPC programmes at the national and facility level 1. IPC programmes 2. IPC guidelines 3. IPC education & training 4. HAI surveillance 5. Multimodal strategies 6. Monitoring/audit of IPC practices and feedback 7. Workload, staffing, bed occupancy 8. Built environment, materials, equipment for IPC Box 2. IPC measures • Hand hygiene • Standard precautions • Transmission-based precautions, including patient identification, placement and use of personal protective equipment • Aseptic technique for invasive procedures (including surgery) • Device management for clinical procedures • Specific guidelines to prevent the most prevalent HAIs adapted to local context (e.g. catheter- associated urinary tract infection (CAUTI), SSI, central line-associated bloodstream infection (CLABI), ventilator-associated pneumonia (VAP)) 2 See http://www.who.int/infection-prevention/tools/core-components/en/. 9 The Surgical Unit-based Safety Programme (SUSP) study performed in African hospitals was discussed to exemplify how IPC helped reduce infections. The SUSP project involved implementing a multimodal strategy – multidisciplinary team, engaged leadership, perioperative teamwork, communication, safety culture, standardized data collection – which emphasized teamwork, partnership and culture change. The project process also enables identification of gaps and factors that led to SSIs, which include inadequate or inappropriate use of surgical antibiotic prophylaxis (SAP), patient bathing, hair removal, surgical hand preparation, surgical skin site preparation, discipline in the operating theatre and sterilization of equipment. Lack of staff training and education as well as patient education was also noted as factors contributing to SSI. Based on the findings, evidence-based infection control elements were implemented and reduction of SSI was achieved.3 WHO has developed resources 4 to support IPC implementation, including protocol for SSI surveillance with a focus on settings with limited resources.5 Key messages for the participants were that IPC should be implemented in an integrated and coordinated manner, with full support of hospital leaders. Also, inspiring and motivating positive behaviours and changing patient safety culture in the hospitals were emphasized. Dr Taneda facilitated a group exercise to illustrate the concept and importance of teamwork. Participants were asked to work in small groups and produced a “Paper Chain”. The teams were asked to produce these in a very short time (2–5 minutes). The game was played multiple rounds and each round team members were asked to rotate tasks, which ranged from cutting paper to connecting loops to make a chain. The results (chains) of each round were compared and different teams took turns in each round to produce the best results (longest and best quality chains), the key message being that a team is only as strong as its weakest chain. Having people in the “right job” improves efficiency. With more skills, people can perform better. Therefore, teamwork is not just about working together, but it is about a common goal, assigning people to do the right job, and empowering them with knowledge and skills. Teams need to constantly review and improve their work processes to find avenues to improve efficiency and performance. Patient satisfaction was a topic repeatedly mentioned by the participants. One discussion centred on the measures and use of patient satisfaction and patient experiences data for improvement. Ms Nittita and Dr Marikar clarified the differences in the concepts of patient satisfaction and patient experience. Increasingly, the term “patient experience” has become more utilized as it provides a notion of qualitative information that can be used for improvement. Patient satisfaction, if measured superficially, may be suboptimal with limited information on what and how improvement can be made. Experts have recommended that health-care providers measure patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) as tools for measuring patient experience for quality improvement. 2.3 Adapting and applying concepts, practices and tools for quality and safety improvement Two hospital visits were organized to provide opportunities for practical learning about the application of concepts, practices, and tools for quality and patient safety in hospital settings. The visit 3 Allegranzi B et al. A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicenter, before-after, cohort study. Lancet Inf Dis, 2018. 4 See http://www.who.int/infection-prevention/tools/en/ 5 See http://www.who.int/infection-prevention/tools/surgical/SSI-surveillance-protocol.pdf 10 to NCGM provided participants with an opportunity to observe several useful medication safety and IPC practices, while the visit to Shinkatsushika Hospital focused on medication safety, patient safety and patient engagement. Below is a summary of key messages from the observations of the NCGM hospital areas: Emergency Department The Emergency Department has the following facilities to reduce the risks of contamination or infections brought into the hospital from outside: • a dedicated washing area near its entrance for incoming patients who might be contaminated • a negative pressure room near its entrance for patients who might have airborne transmissible infectious disease • protocol and processes on sharp and medical waste disposal; equipment • use of equipment to reduce contamination (e.g. disposable bedpans and kidney dishes) • placement of equipment, such as disposable aprons, masks and gloves, are conveniently located next to every bed • sensor-activated taps and soap dispensers to avoid touching and reduce the spread of infections • high alert medications that are labelled; coloured labels used on a white board to show triage status for easy visualization and processing. Pharmacy The Pharmacy has the following facilities: • Medications are ordered through a computerized system, where the electronic system is able to check the prescription for drug allergies, drug–drug interactions and incorrect dosages. • The pharmacist performs additional checks on medications for certain patients, such as children and patients with poor renal function. • High-alert medications (e.g. narcotics, psychotropic drugs) have additional layers of checks using paper forms, and the dispensing pharmacy collects the empty medication bottles/boxes • The pharmacist conducts medication education for patients with special needs, such as those on subcutaneous insulin and/or inhaler medications to teach them how to administer the medications correctly and safely. • For the look-alike/sound-alike medications, the pharmacy adjusts the naming convention for these drugs, for example adding an asterisk to the drug name or using uppercase fonts for some parts of the medication name. Course participants also visited Shinkatsushika Hospital where they learnt how strong patient, family and community engagement can improve health services quality and strengthen patient safety practices as well as create positive experiences for patients and their families. Participants shared the following observations and insights: • Hospital staff demonstrate a strong culture of good IPC practices. Hand sanitizers are placed in strategic and convenient locations around the hospital. Some staff carry their own hand sanitizers. Hospital staff routinely wear face masks. • As the hospital manages a large number of elderly patients, the physical layout of the hospital ward and day-care centres has been designed to be patient-, family- and disability-friendly. 11 • In case of a patient safety incident, the hospital practices full disclosure. There is a dedicated patient safety team that engages the patient and family to inform them of their rights and attends to their needs, including financial support where needed. The hospital visits enabled the course participants to observe how concepts, practices and tools for quality and safety improvement are applied in service delivery. The combination of participatory leaning through the workshop, group discussions and observations during the visits to the hospitals helped them better understand the practical aspects. For example, health-care providers at NCGM carry a small sanitizer bottle with them at all time, either clipped on a belt or a pocket, giving them access to alcohol hand rub. This solution, though simple, was new to the participants. The colour coding of patient wristbands and medicines storage systems are among low-cost solutions for medication safety that are applied in Japan. As part of their practice on priority setting and developing an action plan, participants were encouraged to share which concepts, practices and tools they would adapt and apply to their hospital contexts (Table 3). Table 3. Summary of action plan by country Cambodia Hospital A Issues: High rates of HAIs in ICU SMART Objective: Reduce HAIs in ICU by 50% by end of 2018 Action Plan: • Develop standard operating procedure for clean-up of ICU wards, medical equipment, beds and floor • Develop standard operating procedure for transfer and receiving of patients • Enforce hand hygiene practices • Monitor infections – fever and other symptoms • Investigate HAI cases and isolate infected patients Hospital B Issues: High-rate of SSIs SMART Objective: The number of SSIs in the surgery department is decreased by 20% by six months after project start Action Plan: • Build capacity of all surgical department staff • Develop and strengthen existing IPC protocols and guidelines • Procure equipment and medical supplies for sterilization and cleaning • Conduct training for staff on environment cleaning • Conduct surveillance and monitoring by IPC team. Lao People’s Democratic Republic Hospital A Issues: Patient dissatisfaction with hospital services SMART Objective: Increase patient satisfaction in hospital reception, clinical wards and pharmacy Action Plan: • Establish an evaluation team and implement monthly evaluation meetings and publish reports • Develop a handbook (standard operating procedures) to improve practices for better service • Organize training for all staff • Establish a professional committee regarding treatment plans 12 Lao People’s Democratic Republic • Establish a pharmacy team for medication safety activities; organize a medication storage system Hospital B Issues: Poor infrastructure and service delivery in the emergency room SMART Objective: Strengthening hospital quality and patient safety in the emergency room Action Plan: • Establish medical and nurse committees • Conduct workshops about policy on service quality assurance of 5W1S,6 training of trainers on IPC, drug and therapeutic care, hospital quality control and people-centred care within the hospital • Strengthen the role of the hospital committee and internal audit system in overseeing and monitoring performance • Conduct evaluation and external audit by partners and Ministry of Health • Hold annual meetings to review lesson learnt for the emergency room and model the services to improve quality and patient safety Hospital C Issues: 1. Patients’ distrust of hospital staff 2. Waste management and cleanliness of the hospital environment 3. Poor hand hygiene practices by staff SMART Objective: Improve patient satisfaction and trust as well as waste management and hospital cleanliness in 2018 Action Plan: 1-a) Establish a patient-centred care team in the hospital 1-b) Conduct patient-centred care training for staff 1-c) Investigate priority/high-risk patients, such as the older people, pregnant women and people with disabilities 1-d) Evaluate every three months 2-a) Conduct training about disposal of medical waste 2-b) Improve 5S team 2-c) Clean the hospital once a week and have a big cleaning day every three months 2-d) Evaluate every six months 3-a) Conduct IPC training for all staff 3-b) Provide IPC equipment including hand sanitizer Mongolia Hospital A, B and C: The participants from Mongolia worked in three different hospitals. During the discussion, they decided to work as one group and presented a joint action plan. Issues identified: HAIs SMART Objective: Reduce the rate of catheter-associated urinary tract infection (CAUTI) in the hospitals’ IC units by 30% in 2018 Action Plan: • Establish a baseline by preliminary investigation • Train health-care providers on IPC • Develop a protocol for insertion and care of urinary catheter and monitor 6 5W1S stands for the Lao People’s Democratic Republic’s national policy on quality – “Five Good One Satisfy” for health care at all steps and levels (No. 1861/Ministry of Health, 5 August 2016): 1) Well Warm Welcome, 2) Well Cleanliness, 3) Well Convenience, 4) Well Accurate Diagnosis, and 5) Well and Quick Treatment. The “One Satisfy” is Satisfaction of Patients. 13 protocol adherence • Improve rate of hand hygiene practice Philippines Hospital A Issues identified: Rate of HAIs in the hospital is higher than the national target (4–6% vs 2%) SMART Objective: • To decrease HAI to 2% in six months by strengthening adherence to basic compliance of hand hygiene Action Plan: • Set up a system to link nurses on each ward • Provide personal portable alcohol rub dispenser to each health-care worker (for convenience and access) • Develop protocols for insertion and care of urinary catheter • Procure and install CCTV in the entry/exit of wards (where there are alcohol hand rubs) to monitor hand hygiene • Procure priority equipment in the microbiology laboratory Viet Nam Hospital A Issues: 30% diabetic patients do not follow doctor’s instructions on medication and recommended diet SMART Objective: Reduce the proportion of outpatient department diabetic patients who do not follow doctor’s instructions from 30% to 10% in one year Action Plan: • Conduct training to improve staff knowledge and skills on communication and supporting patient • Monitor health providers’ behaviours (in relation to interactions with patients) • Create a checklist for patients to follow doctor’s directions Hospital B Issues: HAIs and inappropriate use of antibiotics, especially in the surgery department SMART Objective: • Reduce nosocomial pneumonia incidence among ICU patients from 15% to 10% among in one year • Reduce SSI incidence of patients in the surgery department from 6.8% to less than 5% in one year. • Increase the rate of appropriate antibiotic prophylaxis prescriptions from 0% to 30% in one year in the surgery department Action Plan: • Update procedures for respiratory tract care and surgical patient preparation • Develop checklists of bundles of care to prevent nosocomial pneumonia and SSIs • Provide training on HAI diagnosis, based on Centers for Disease Control and Prevention (CDC) criteria, and nosocomial pneumonia and SSI prevention for health-care providers • Establish systems for surveillance of nosocomial pneumonia and SSI rates, monitor compliance of health-care staff with SSI and nosocomial pneumonia prevention procedures • Report surveillance results to the hospital executive • Strengthen IPC doctor and nurse networks 14 2.4 Hospital quality and patient safety management network On the final day of the course, the participants discussed developing a quality and patient safety management national network to provide peer support and share knowledge. Prior to coming to the course, the participants were asked as part of their preparation to engage with previous course participants in their respective country to find out how the past participants use the knowledge and skills learnt from the course and which areas of knowledge and skills they found useful and relevant to their work. The following was the feedback from participants in previous courses: • Learning about best practices and initiatives of other countries, particularly from Japan • Measuring quality and safety, hospital management; raising awareness of hospital personnel and patients to equip them with information, tools and techniques to design and implement future action plans • Hospital visits to observe actual implementation of quality management practices • Specific skills for quality and patient safety such as the Kaizen method and 5S • Knowledge of global health agenda such as the SDGs, UHC, people-centred care and equity in access to service The participants also shared that the previous cohorts of course participants made significant contributions to their country in the areas of hospital quality and patient safety. They cited several activities and areas that the previous cohorts of participants have worked on: 1) Strengthening quality and patient safety in (their workplace) hospital • Former participants from Mongolia first introduced quality management standards (ISO9007:2008) and then pursued continuous improvement of the quality and safety of their services. • Former participants from Viet Nam focused their efforts on changing people’s perception about patient safety incidents through discussion with boards of directors and chief nurses at monthly meetings. 2) Changing policy and resolution • Contributed to the draft “Policy document and Strategy on Strengthening Quality and Safety of the Healthcare 2018–2022” (Mongolia) 3) Conducting patient safety courses for other hospital staff • Organized a seminar on “Patient safety of the elderly and disabled people” for hospitals and health-care providers in Ulaanbaatar (Mongolia) • Conducted a weekly education course for patient and their family (Lao People’s Democratic Republic) • Held training and workshops for sharing experiences on patient safety 4) Planning for quality and safety • Created a plan for evaluation and measurements of quality improvement activities (Viet Nam) • Elaborated indicators for staff performance and behaviours and created an evaluation plan to incentivize staff based on the indicators (Lao People’s Democratic Republic) 5) Developing patient safety incident reporting system 15 • Developed a nationwide incident report system and established an online adverse event report system at hospital level (Viet Nam) 6) Awareness raising • Raised awareness about patient safety issues by conducting a mass media campaign (Cambodia). Inspired by previous course participants who have continued to use the skills and knowledge they gained from this course to advance quality and patient safety work in their respective country and hospital, the participants unanimously agreed to establish a regional hospital quality and patient safety management network for peer support and knowledge sharing. As part of the commitment to the network, the course participants and the faculty agreed to: • actively share articles and knowledge pertaining to hospital quality and patient safety with the network; • organize at least two webinars on topics related to hospital quality and patient safety over the next year; and • develop a practical guide with a set of actions that hospital leaders can take to improve quality and patient safety in their hospitals. Participants also suggested that similar knowledge-sharing networks be established in their countries at the national level and to include mid-level managers to build up a community of practice. The participants indicated that they would follow up on this idea with the previous cohorts of participants and would request support from their respective health ministry and WHO country office. 3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions The course helped strengthen participants’ knowledge about the role of hospitals in health systems, in particular their essential role in providing safe, quality and people-centred health services, responding to outbreaks and medical emergencies, strengthening primary health care, providing clinical education and supporting public health, especially in the areas of disease surveillance and infection prevention. These roles are critical to accelerate progress towards UHC. Topics added to this year’s course included: quality improvement through external evaluation (certification, licensing and accreditation); IPC, including surveillance and outbreak responses; and medication safety. This year’s course format was revised to improve learning and participation. Participants progressively developed action plans through small daily sessions. Feedback and reflection sessions concluded each day. The country action plans focused on staff capacity strengthening, improving links between departments in hospitals and with primary health care services, and building networks of professionals. More specifically, by country: • Cambodia’s two plans focused on IPC, aiming to reduce HAIs (in intensive care units) and SSIs. • The Lao People’s Democratic Republic’s two plans focused on strengthening hospital quality and patient safety in emergency departments and making services more people- centred by improving patients’ experiences and trust in hospital services. 16 • Mongolia’s plan focused on reducing catheter-associated urinary tract infections. • The Philippines’ plan aimed to reduce HAIs in the children’s hospital. • Viet Nam’s two plans aimed to improve adherence to prescribed treatments for diabetic care in outpatient departments, reduce HAIs and SSIs, and improve the appropriate use of prophylaxis antibiotics prescriptions by surgical departments. Feedback from past course participants indicated what they found most useful for their work: tools and methods to measure quality and safety and raise awareness of hospital staff and patients, as well as good practice examples. They also appreciated increasing their knowledge of global and regional health issues such as the SDGs, UHC and equitable integrated people-centred services. Participants agreed to formally and effectively engage past course participants as well as participants from other WHO quality and patient safety meetings. They requested that the respective WHO country offices convene and facilitate the first meeting to help establish a health-care quality and patient safety management national network. 3.2 Recommendations 3.2.1 Recommendations for Member States Member States are encouraged to do the following: 1. Develop national health-care quality and patient safety management networks comprising previous course participants and other relevant health policy-makers and professionals, with specific terms of reference, action plans and regular (preferably quarterly) meetings. 2. Facilitate collaboration of the national health-care quality and patient safety management networks with those working on other quality improvement activities and support the sharing and scale-up of good practice implementation in line with the action plan and terms of reference. 3. Facilitate the national health-care quality and patient safety management networks to collect, collate and share case studies of good practices in management, patient safety and quality improvement. 4. Support an evaluation of the impact of the hospital quality and patient safety management courses held thus far to understand: how participants have used the knowledge and skills learned to implement the action plans developed, what support is needed for more effective implementation, which areas of knowledge and skills are more useful, and what capacities need further strengthening. 3.2.2 Recommendations for WHO WHO is requested to do the following: 1. Support Member States to convene in-country meetings to establish the national health-care quality and patient safety management networks. 2. Support in-country evaluations of the impact of the hospital quality and patient safety management courses and implementation of action plans developed during the courses. 17 3. Provide guidance and support for implementation of action plans to improve hospital quality and patient safety management and facilitate the health-care quality and patient safety management networks. 4. Help collect and disseminate good practices in implementing quality and safety improvement, IPC and people-centred integrated services. 18 ANNEXES Annex 1. List of participants, temporary advisers, observers, Secretariat and resource persons 1. PARTICIPANTS Dr NHIP Angkeabos, Director, National Pediatric Hospital, 100 Federation of Russia Blvd., Khan Toul Kork, Phnom Penh, Cambodia. Tel. No.: 855 885 1181 1132; Email: nhepangkeabos@nphkh.org Dr HUOT Chantheany, Vice Director, National Pediatric Hospital, 100 Federation of Russia Blvd, Khan Toul Kork, Phnom Penh, Cambodia. Tel. No.: 855 122 46307, Email: chantheanyhuot9@gmail.com Dr YIN Sinath, Director, Kampong Cham Provincial Hospital, 25 Prah Ketomealea Street, Sangkat Vealvong, Kampong Cham, Cambodia. Tel. No.: 855 1268 2808, Email: yinsinath@gmail.com Dr CHAP Chanthida, Deputy Director of Provincial Referral Hospital, Kampongcham Province, Kampong Cham, Cambodia. Tel. No.: 855 1242 0002, Email: ccthidamtd@gmail.com Dr Phisith PHOUTSAVATH, Deputy Director General, Mahosot Hospital, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic. Tel. No.: 856 20 9996 6198, Email: psavath@gmail.com Dr Bounmy SOMSAMOUTH, Deputy Director General, Setthathirath Hospital, Vientiane, Lao People's Democratic Republic. Tel. No.: 856 20 5549 8009, Email: somsamouthbounmy@gmail.com Dr Vansana HANSACKDA, Chief of Internal Medicine Unit, Sekong Hospital, Maihuameaung Village, Laman District, Sekong Province, Lao People's Democratic Republic. Tel. No.: 856 20 2220 5757, Email: vansanahsd@gmail.com Dr Oyunkhand RAGCHAA, Director, Department of Policy and Planning, Ministry of Health, Government Building VIII, Olympic Street-2, Ulaanbaatar 14210, Mongolia. Tel. No.: 975 9915 3923, Email: ragchaah@yahoo.com; r.oyunkhand@gov.moh.mn Dr Tsevegdorj GANZORIG, Medical Director, Second General Hospital, Bayanzyrkh District, Ulaanbaatar, Mongolia. Tel. No.: 976 9913 6188, Email: docgonza@yahoo.com Dr Dulamragchaa CHIMEDBAZAR, Quality Assurance Manager, National Center for Maternal and child Health, P.O. Box 867, Ulaanbaatar, Mongolia. Tel. No.: 976 9901 8130, Email: duyaa.dr@gmail.com 19 Dr Munkhchimeg BATCHULUUN, Epidemiologist Khan-Uul District Hospital, Ulaanbaatar, Mongolia. Tel. No. : 976 9669 2229, Email: jbc_112298@yahoo.com Dr Philip MORALES, Medical Specialist IV, National Children's Hospital, 264 E. Rodriguez Sr. Blvd, Quezon City, Philippines. Tel. No.: 639 25 6777 990, Email: philipm777@yahoo.com Dr TRAN VIET Tiep, Director of Hospital, Tue Tinh Street, Thanh Son Ward, Uong Bi City Quang Ninh Province, Viet Nam. Tel. No.: 84 913 355 938, E-mail: trantiep938@gmail.com Dr NGO QUY Chau, Vice Director, Bqch Mai Hospital, 78 Gian Phone, Dong Da Hanoi, Viet Nam. Email: ngoquychaubmh@gmail.com Dr NGUYEN THI THU Ha, Chief of Quality Management Office, Tue Tinh Street, Thanh Son Ward, Uong Bi City, Quang Ninh Province, Viet Nam. Tel. No.: 84 9 8847 3151, Email: thuhad7@gmail.com Dr TRUONG ANH THU, Deputy Head of Infection Control Department, Bqch Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam. Tel. No.: 84 9 0419 8118, Email: thuksnk@gmail.com 2. TEMPORARY ADVISERS Dr Kadar MARIKAR, MSQH, B-G1, Level 6, Menara Wisma Sejarah, 230 Japan Tun Razak, 50400, Kuala Lumpur, Malaysia. Tel. No.: 603 2681 2232, Email: kmarikar@gmail.com Dr Shinichiro NODA, Senior Expert in Partnership Development, Department of Global Network and Partnership, Bureau of International Health Cooperation, National Center for Global Health and Medicine. Tokyo, Japan. Email: noda@it.ncgm.go.jp Dr Clive TAN, Head Healthcare (Medical Policy & Governance) and Head Healthcare Informatics, Military Medicine Institute, Consultant (Public Health), SAF, Consultant (Public Health), Ministry of Health, College of Medicine Building, 16 College Road, Singapore 169854. Tel. No.: 665 00953, Email: clivetan@gmail.com 3. OBSERVER Ms Samsiah AWANG, Pharmacist (Researcher), Head of QA Secretariat Division, Institute for Health Systems Research, Ministry of Health , Suites 55-1, 55-2, 55-4, 55-4 Setia Avenue, No. 2 Jalan Setia Prima S U13/S, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor, Malaysia. Tel. No. : 603 3346 6400 ext 472, Email: samsiah.a@moh.gov.my 20 4. WHO SECRETARIAT Ms Nittita PRASOPA-PLAIZIER, (Responsible Officer), Technical Officer, Education and Capacity Development, Division of Health Systems, WHO Regional Office for the Western Pacific, 1000 Manila, Philippines. Tel. No.: 632 528 9086, Email: prasopaplaiziern@who.int Ms Sohyun KIM, Go WHO Korea Fellow, Division of Health Systems, WHO Regional Office for the Western Pacific, 1000 Manila, Philippines. Tel. No.: 632 528 9837, Email: sokim@who.int Dr Benedetta ALLEGRANZI, Coordinator, Infection Prevention and Control Global Unit, Service Delivery and Safety, Health Systems and Innovations, World Health Organization, 20, Av Appia, CH-1211, Geneva 27, Switzerland. Tel. No.: 41 22 791 2689, Email: allegranzib@who.int Dr Jolanta GRISKEVICIENE, Technical Officer, Service Delivery and Safety, Health Systems and Innovations, World Health Organization, 20, Av Appia, CH-1211, Geneva 27, Switzerland Tel. No.: 41 22 791 1804, Email: griskevicienej@who.int 5. NIPH SECRETARIAT Dr Tomofumi SONE, Vice President, National Institute of Public Health, Ministry of Health, Labour and Welfare, Japan, 2-3-6 Minami, Wako-shi, Saitama 351-6111, Japan. Email: sonetom@niph.go.jp Dr Hiroko MIURA, Director, Department of International Health and Collaboration, National Institute of Public Health, , Ministry of Health, Labour and Welfare, Japan, 2-3-6 Minami, Wako-shi, Saitama 351-6111, Japan. Email: miura.h.aa@niph.go.jp Dr Kenichiro TANEDA, Chief Senior Researcher, Department of International, Health and Collaboration, National Institute of Public Health, Ministry of Health, Labour and Welfare, Tokyo, Japan. Email: kentaneda@gmail.com Dr Takuya MATSUSHIGE, Senior Researcher, Department of Health and Welfare Service, National Instute of Public Health, Ministry of Health, Labour and Welfare, Tokyo, Japan. Email: matsushige.t.aa@niph.go.jp 6. RESOURCE PERSONS Mr Jimbo KATSUYA, Deputy General Manager, Japan Council for Quality Health Care, Toyo Bldg., 1-4-17, Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan Dr Norio OHMAGARI, Deputy Director General, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan. Email: nohmagari@hosp.ncgm.go.jp Mr Akinobu KOBAYASHI, Deputy Director of Pharmacy Department, Center Hospital - Pharmacist, Medical Safety and Risk Management Office, National Center for Global Health and Medicine, Tokyo, Japan. Email: akkobayashi@hosp.ncgm.go.jp 21 Ms Hisae HATTORI, Head Nurse, Medical Safety and Risk Management Office, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan. Email: hhattori@hosp.ncgm.go.jp Dr Taketo TANAKA, Medical Officer, Department of Human Resource Development, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan Mr Akinobu KOBAYASHI, Pharmacist, Medical Safety and Risk Management Office, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan. Email: akkobayashi@hosp.ncgm.go.jp Mr Kazuki MIYAZAKI, Registered Nurse, Department of Global Network and Partnership, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan. Email: kmiyazaki@hosp.ncgm.go.jp Ms Ikuko TOYODA, Patient Support Section/Patient Safety Management Office, Shinkatsushika Hospital, 3-26-5 Horikiri, Katsushika-ku, Tokyo 124-0006, Japan. Email: ikuko.toyoda@ims.gr.jp Dr Tomoko KAMEI, Professor, St. Luke's International University, Graduate School of Nursing, Director, WHO Collaborating Center for People-Centered Care, Director, Research Center, Division of PCC Development, 10-1 Akashi-chou, Chuo-ku, Tokyo, Japan 104-0044. Email: Kamei@slcn.ac.jp Ms Yoshinori MATSUDA, St. Luke's International University, 10-1, Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. Tel. No.: 81 3 5550 2262, Email: yosmatsu@slcn.ac.jp Ms Yasuko NAGAMATSU, St. Luke's International University, 10-1, Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. Tel. No.: 81 3 5550 2262, Email: sarah-nagamatsu@slcn.ac.jp Dr Shiro MATAKI, Professor, Dental Hospital, Tokyo Medical and Dental University 22 Annex 2. Programme of activities Time Session Moderator Day 1: Hospital and Health System, 12 Mar 2018, NIPH 07:00 – 09:00 Travel and Registration 09:00 – 09:30 Opening session • Welcome remarks o Dr Kazuya Shimmura (President, National Institute of Public Health Japan) o Mr Toru Kajiwara, Director, Office of Global Health Cooperation, International Affairs Division, Ministry of Health, Labour and Welfare o Ms Nittita Prasopa-Plaizier, Integrated Service Delivery, Division of Health Systems, WHO Regional Office for the Western Pacific) • Group Photo Dr Kenichiro Taneda 09:30 – 10:30 Introduction and Course Objectives • Self-introduction by all participants. • Country participants briefly share information on: o Your role in hospital management, hospital service quality or patient safety) o Specific knowledge and skills you expect to gain from the course Ms Nittita Prasopa- Plaizier Dr Kenichiro Taneda 10:30 – 11:00 Break 11:00 – 11:50 Introduction and Course Objectives • Self-introduction by all facilitator with detailed background Ms Nittita Prasopa- Plaizier Dr Kenichiro Taneda 11:50 – 13:00 Lunch 13:00 – 14:30 Group Work 1: Participants experiences and expectations • Building a network of hospital management for quality and patient safety Ms Nittita Prasopa- Plaizier Dr Clive Tan 14:30 – 15:20 S1. Sustainable Development Goals (SDG) and Universal Health Coverage (UHC) : Equity and Health Care Quality • Improving healthcare quality to accelerate progress towards UHC and contribute to SDGs Ms Nittita Prasopa- Plaizier 15:30 – 15:50 Break 15:50 – 16:40 S2: Quality - an attribute for high-performing health system • Creating enabling environment for people-centred, integrated service delivery • Improving quality, patient safety in hospital – what are your priorities? Dr Ken Taneda Dr Kadar Marikar 16:45 – 17:20 Group Work 2: Action plan for patient safety and quality – Systems strengthening • Action plan for strengthening hospital management to improve quality and patient safety in hospital Dr Kenichiro Taneda Dr Clive Tan Dr Kadar Marikar Dr Shin-ichiro Noda 17:20 – 18:00 Reflection/Feedback All 18:00 Welcome Reception 23 Time Session Moderator Day 2: Quality and Patient Safety, 13 Mar 2018, NCGM 08:00 – 09:00 Travel to NCGM 09:00 – 09:30 Introduction to the topic; Infection Prevention and Control Ms Nittita Prasopa- Plaizier 09:30 – 10:45 S3. Strengthening hospital management for implementation of IPC, AMR, WASH • Translating policy to local action o Core components for Infection Prevention and Control (IPC) o Prevention and Control of Antibiotic Resistance (AMR) o Global Action plan for Water Sanitation Hygiene (WASH) o Surveillance and Monitoring Dr Benedetta Allegranzi Dr Jolanta Griskeviciene 10:45 – 11:00 Break 11:00 – 11:30 S4. Implementing IPC practices in hospital – making it work! • Good practices of IPC implementation at hospital level Dr Benedetta Allegranzi Dr Jolanta Griskeviciene 11:30 – 12:10 Group Work 3. How IPC are implemented in your hospital and Country? All 12:10 – 13:00 Lunch 13:00 – 13:40 NCGM Welcome • Dr Eiji Hinoshita, Director General, Bureau of International Health Cooperation S5a: Activities for IPC in NCGM • IPC practice and patient safety at NCGM Dr Shinichiro Noda Dr Norio Ohmagari 13:40 – 14:15 S5b: Activities for Patient Safety in NCGM – Pharmacy • IPC practice and patient safety at NCGM Mr Akinobu Kobayashi Ms Hisae Hattori Dr Shinichiro Noda 14:15 – 15:40 S6: Hospital visit in NCGM • Visit to Reception and waiting area in OPD, visit to Pharmacy (safe drug management) and visit to ER (IPC activities) Dr Shinichiro Noda Dr Taketo Tanaka Mr Kazuki Miyazaki 15:40 – 16:00 Break 16:00 – 17:00 S7: Case discussion – Outbreak Response • Influenza outbreak in NCGM and response strategy • Process of investigation and result Dr Masahiro Ishikane Dr Shinichiro Noda 17:00 – 17:25 S8: Case discussion regarding WHO IPC guideline Dr Benedetta Allegranzi 17:25 – 18:00 Reflection & wrap up Ms Nittita Prasopa- Plaizier Dr Kenichiro Taneda 24 Time Session Moderator Day 3: Leadership and Hospital Management, 14 Mar 2018, NIPH and Hospital 09:00 – 09:30 S9. Leadership and hospital performance • Leading by example – what can leaders do to improve hospital performance Ms Nittita Prasopa- Plaizier Dr Kadar Marikar Dr Kenichiro Taneda 09:30 – 10:30 S10. Strengthening hospital management for quality and patient safety • Japan’s experience Dr Shiro Mataki Dr Kenichiro Taneda 10:30 – 11:00 Break 11:00 – 12:00 Group Work 4. Quality improvement & team work simulation • Simulation • Redesigning systems for quality and people-centred services Dr Kenichiro Taneda Dr Clive Tan 12:00 – 13:40 Lunch and Travel to Shin-katsushika Hospital 13:40 – 14:30 S11a: Introduction of Shin-katsushika Hospital and Patient & community Activities for Quality and Patient Safety • Patient, family and community engagement for patient safety Dr Kenichiro Taneda Ms Ikuko Toyoda 14:30 – 14: 45 Break 14:45 – 16:20 S11b: Shin-katsushika Hospital Visit • Visit Pharmacy in the hospital • Visit Dialysis centre in the hospital • Visit Rehabilitation centre in the hospital Staff of Shin- katsushika Hospital Dr Kenichiro Taneda Dr Shinichiro Noda Dr Takuya Matsushige 16:20 – 17:00 Q & A 17:00 – 17:50 Travel to Accommodation 25 Time Session Moderator Day 4: Quality for Integrated Service Delivery, 15 Mar 2018, NIPH 08:30 – 09:00 Reflection and Feedback for Day 3 Ms Nittita Prasopa- Plaizier Dr Kenichiro Taneda 09:00 – 09:20 Ice-break for Healthcare accreditation topic Ms Nittita Prasopa- Plaizier 09:20 – 10:20 S12a. Healthcare accreditation and healthcare quality • External evaluation, including accreditation • Healthcare accreditation - Japan experiences Mr Jimbo Katsuya (JQ) Dr Kenichiro Taneda 10:20 – 10:40 Break 10:40 – 11:30 S12b. Healthcare accreditation and healthcare quality • Healthcare accreditation - Malaysia experiences Dr Kadar Marikar 11:30 – 11:50 Introduction of performance management Ms Nittita Prasopa- Plaizier 11:50 – 12:20 Group Work 5a. Action plan for strengthening hospital management for quality and patient safety • Re-designing systems for quality and people-centred services Dr Clive Tan 12:20 – 13:00 Lunch 13:00 – 14:00 S13: People-centred health service & simulation • Simulation – Experience elder people and share learning Dr Kenichiro Taneda 14:00 – 15:30 S14: People-centred health service and patient & family engagement • Patient, family and community engagement - Japan and Singapore experience Dr Tomoko Kamei Dr Yasuko Nagamatsu Dr Clive Tan 15:30 – 16:00 Break 16:00 – 17:00 S15. Group discussion about ‘Quality and Patient Safety Management Training Course (QPSM)’ • Enhance network of QPSM participants – What former participants’ learnt and How apply their learning • Strategy for sustainable network and collaborate to tackle own challenges All 17:00 – 17:30 Group Work 5b. Action plan for strengthening hospital management for quality and patient safety • Re-designing systems for quality and people-centred services 26 Time Session Moderator Day 5: From Policy to Action, 16 Mar 2018, NIPH 09:00 – 10:00 S16. Accountability & Governance • Key discussion • Accountability and Governance in hospital :Information transparency, Learning from Adverse event • Feedback from patient and community : Managing system and service evaluation Dr Kenichiro Taneda Ms Nittita Prasopa- Plaizier 10:00 – 10:30 Group Work 5c. Action Plan for strengthening hospital management for quality and patient safety All 10:30 – 11:00 Break 11:00 – 12:00 S14. Country Workplan & Presentation • Group Activities o Making action plan for own hospital/countries – focused on learning from this course o Present action plan All 12:00 – 13:00 Lunch 13:00 – 14:00 S16: Closing • Wrap up and closing Dr Kenichiro Taneda End of Programme 27 Annex 3. Opening remarks of Dr Shin Young-soo, WHO Regional Director for the Western Pacific Dr Kazuya Shimmura, President of the National Institute of Public Health; Mr Toru Kajiwara of the Ministry of Health, Labour and Welfare; Participants of the Fifth Hospital Quality and Patient Safety Management Course, representatives of WHO collaborating centres; invited experts and colleagues; Ladies and gentlemen: 1. First, I would like to extend a warm welcome to everyone – participants, facilitators and organizers – to the Fifth Hospital Quality and Patient Safety Management Course. Dr Shin Young-soo, WHO Regional Director for the Western Pacific, regrets not being able to join us due to prior commitments. He has asked me to convey his regards and deliver these words. 2. This is the fifth year of the Hospital and Quality and Patient Safety Management course. The course is designed to strengthen capacity of health leaders and hospital managers in countries across the Western Pacific Region. It is a testament of the unwavering support of the Japan's Ministry of Health, Labour and Welfare, our strong collaboration with the National Institute of Public Health and the National Centre for Global Medicine and other WHO collaborating centres. 3. It is also a testament of our collective commitment to support the quality, safety and effectiveness of hospital services for achieving universal health coverage. 4. Over the years, countries have implemented strategies to improve health-care quality and patient safety. Patient safety incidents, such as medication and blood transfusion errors, wrong-site surgeries and health-care-associated infections, pose a heavy burden to patients, their families and communities. They also affect the security of health workers and increase costs to the health-care system. They are often caused by unsafe practices that persist due to poor management and system failure. 5. Applying a whole-of-system approach that emphasizes good organizational governance, competent management and skilled health-care professionals is critical for improving quality and patient safety. The regional framework on Universal Health Coverage: Moving Towards Better Health, which was endorsed by Member States in 2015, recognizes quality as a core health system attribute that must be strengthened to accelerate progress on universal health coverage. The celebration of the World Health Day this year will focus on universal health coverage including health care and patient safety. 6. This year is special. One of the course objectives is to create a formal national network of course alumni of health leaders and senior hospital managers. These people can be change agents and champion for improving health care quality and patient safety. During the past four years, the course has produced more than 60 graduates and created an informal network. It is time that we take stock, to hear formal feedback and engage all graduates to advance the universal health coverage agenda by improving the quality and safety of health care and services. 7. This year, you will note the addition of sessions on Infection Prevention and Control and health-care accreditation for quality improvement. Technical staff from WHO, along with experts from Japan, Malaysia and Singapore will join the Faculty to provide in-depth 28 knowledge about the topics. The field visits to hospitals will provide opportunities to interact with hospital managers and health-care providers on how to apply practical quality and patient safety principles in every day service delivery. 8. As a former hospital administrator, I understand the challenges you face. Making changes to the system is difficult. Changing behaviour is equally difficult. Advanced treatment modalities, new medicines and medical technologies have enhanced service delivery, but we still face complex challenges. The rapid pace of population ageing, the rise of noncommunicable diseases, and emerging diseases and infections have increased burden on health-care systems with limited resources. 9. We need innovations – to do things in ways that improve effectiveness, efficiency, quality and patient safety in hospitals. It is critical that we improve systems and management and strengthen the capacity of our health workforce as well as integrate patient, family and community engagement into all aspects of hospital service delivery. 10. On behalf of WHO, I would like to, once again, thank the National Institute of Public Health for your continued partnership in co-organizing this course with us. I very much appreciate the contribution of the National Centre for Global Health and Medicine and St Luke's International University, which are also WHO collaborating centres, as well as the Japanese Council for Quality Health Care, the Malaysian Society for Quality in Health Care and the Ministry of Health Singapore for your invaluable contributions. I also want to thank our WHO colleague from headquarters who makes a great contribution to raising awareness of the importance of infection prevention and control. 11. Lastly, a special word to the participants: thank you for your active participation. I wish you a successful learning journey, and I look forward to your continued commitment to improving quality and patient safety back in your country. WHO, as always, stands ready to collaborate with Member States to help achieve universal health coverage, good health and well-being for all. 12. Thank you. 29 Annex 4. The WHO IPC Global Unit Main functions: 1. Leadership, connecting and coordinating 2. Campaigns and advocacy 3. Technical guidance and implementation 4. Capacity-building 5. Measuring and learning. The key technical areas of work: • Hand hygiene • Prevention of surgical site infections • IPC to combat antimicrobial resistance • Injection safety • Burden of health care-associated infections • Ebola response and recovery • IPC country capacity-building • Prevention of sepsis and catheter-associated bloodstream infections • Prevention of catheter-associated urinary tract infections. Key resources and tools developed by WHO IPC Global Unit • Various tools for monitoring of various IPC practices: http://www.who.int/infection- prevention/tools/en/ • Protocol for surgical site infection surveillance with a focus on settings with limited resources. http://www.who.int/infection-prevention/tools/surgical/SSI-surveillance- protocol.pdf?ua=1 • IPC core components at the national and acute health care facility level http://www.who.int/infection-prevention/tools/core-components/en/ IPC core components at the national and acute health care facility level • Core component 1: IPC programmes: • Core component 2: IPC guidelines • Core component 4: HAI surveillance • Core component 3: IPC education & training • Core component 5: Multimodal strategies • Core component 6: Monitoring/audit of IPC practices and feedback • Core component 7: Workload, staffing, bed occupancy (facility level) • Core component 8: Built environment, materials, equipment for IPC (facility level) www.wpro.who.int