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210-1229 / Strategy for Improving Patient Safety in Primary Care at Regional Level

Spain
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Quality territorial commission of Tarragona

Topic

Patient safety system
Accreditation
Category
Patient safety culture / Patient safety climate
There is no specified text here
GOP Description
 
Implementation level
Regional
Local
Clinical settings
It has been implemented in primary care centers in Tarragona
Objectives
The main objective is to design, implement and evaluate a strategy to improve the patient safety in the primary care in Cataluna, incorporating proactive and reactive methods in patient safety.
Population
The strategy is aimed at primary care governance territory composed of 20 health centers, which serve a population of 338,769 users assigned.
Methods
 
Methodology
The first task was the evaluation of health centres using the Health Department Accreditation Model (MADS), called "sine qua non (SNQ)”.This model was inspired by the European Foundation for Quality Management (EFQM) and the Joint Commission International (JCI) accreditation standards. This model was designed by a panel of experts in quality as well as scientific societies from our autonomous community. The model contains 347 standards. In 2011 a self-assessment was conducted using MADS, followed by audits in 2012 and in 2013. Finally, in 2014 a new self-assessment and a final evaluation following MADS was conducted.
The second task was to designed a Patient Safety Manual, using the standards related to safety (33 Sine Qua Non (SNQ) standards out of the total 347) to reduce the variability due to the actions of the professionals.
The manual helped us achieve the standard sine qua non (SNQ 33) in the first audits (2012 and 2013), before the final MADS evaluation, using all 347 standards, was conducted in 2014.
The third task was to create a software application to carry out preventive activities "checklist"(PROSP), designed using the Patient Safety Manual.
And the last task was to implement an incident reporting system: The Patient Safety Company (TPSC_Cloud), to identify our critical areas, learn from our mistakes and make sure they don’t happen again.
Timeframe implementation
Evaluation following the Health Department Accreditation Model (MADS): 2011-2015
Design a patient safety manual: 2011-2015
Create a software application to carry out preventive activities "checklist" (PROSP): 2013-2015
Implement incident reporting system The Patient Safety Company (TPSC_Cloud): 2013-2015
Implementation tools available
Evaluation using the Health Department Accreditation Model (MADS): We have an instrument or the IT program online for the evaluation. We trained all the professionals in quality concepts and patient safety (classroom and online)

Design the patient safety manual: We used an online platform and the collaboration of the 330 professionals who are part of the improvement teams under the leadership of the Territorial Quality Commission.
And for the implementation process, a communication plan was designed to present the manual as well as training for all the professionals involved in its implementation.

Create a software application to carry out preventive activities "checklist" (PROSP): We have an instrument or the IT program online where to carry out preventive activities.
Implement incident reporting system: The Patient Safety Company (TPSC_Cloud): We have an instrument or the IT program on line where to notify and to analyze incidents.
And for the implementation process we designed a new communication plan to present the TPSC_Cloud and PROSP and training for all the professionals involved in its implementation
Implementation cost
We assigned two professionals full time to lead the project.
Results
 
Method used to measure the results
Evaluation following the Health Department Accreditation Model (MADS): In 2011, 2014 and 2015 we used the results into the platform online (IT program)
In 2012 and 2013 we used the results of the audits of 33 standards SNQ.
Implement incident reporting system The Patient Safety Company (TPSC_Cloud): we used the notified incidents in IT program.

Results
Evaluation following the Health Department Accreditation Model (MADS):
In 2011 each centre had a different starting situation, but in 2013 the audit results showed that 100 % of the centres of primary care had achieved 100% of the 33 standards SNQ.
In 2014/2015 all the centres had achieved more than 80% of the MADS 347 standards
We trained in Quality and Patient Safety concepts a total of 656 professionals.

Create a software application to carry out preventive activities "checklist"(PROSP): we trained 250 professionals. All the centres did the checklist with this program.

Implement incident reporting system The Patient Safety Company (TPSC_Cloud): A total of 1350 incidents were reported from June 2013.
Analysis of the results

With the first self-assessment held in 2011 we could identify different critical areas in our territory:
• Availability of different plans: the centres didn’t have allof the following plans: Quality plan that includes patient safety , communication plan and admission plan.
• We didn’t have the control of the expiration date of the material in the centres.
• We identified various critical areas related to: emergency care, safe use of medication, infection prevention and surveillance system...

These critical areas were used to prioritize the processes. We developed the Patient Safety Manual with its 11 processes to reduce variability due to professionals and promote patient safety. To carry out the preventive activities the software application PROSP was developed.
The training for the professionals has been very important in reducing variability and promote the culture of quality and patient safety
We can conclude that the implementation of this strategy will improve outcomes, in 2014 reaching 100% of the implanted model 33 SNQ standards ,and in 2014/2015 all the centres had achieved more than 80% of the standards of the MADS (347 standards).

Implement incident reporting system The Patient Safety Company (TPSC_Cloud): With the incident notification we have detected critical areas and have developed safe practices and sanitary alerts.
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
1-Self-assessments and audits: Lack of knowledge and culture of self MADS and economic environment.
2-How to implement a manual patient safety integrated by different processes at all centers?
3-In the process of application design, the most obvious difficulty was concerning how to translate manuals into computer language different checklist.
4-Lack of training in reporting tool
Describe the strategies used to overcome the barriers (If needed)
1-Training program: MADS need to implement EAP?
The audit is a process oriented consulting and support.
2-Methodology of participatory work improvement teams and monthly meetings. They are the professionals who know who the design process.
3-Improvement teams composed of the unit responsible for information technology, the reference territorial quality and programmer responsible process. An action plan with scheduled meetings is set.Trainning program.
4-Trainning program.
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
This project has been an opportunity to implement a strategy for improving patient safety. From the evaluation process, the roadmap aimed at defining, implementing and evaluating proactive and reactive strategies in patient safety was defined. A key point was the design manual safety of patients and the development of PROSP application, that has reduced the variability of care, facilitate the work of professionals and management and evaluation processes. Another aspect is that we are learning from incident reporting. In any strategy related to patient safety, culture is key professionals who have reported incidents in order to learn from them, redesigning processes and make them more robust.
Just make a special mention to illusion, professionalism and commitment of all professionals in the region, we think we have discovered a new way to a new workflow integrated, service-oriented and ensuring health care of the highest quality.

20151129102128356_771_GOP_RESULTS.doc
Contact information
 
Name: yolanda caules
Position/function: general practitioner
Department: Primary Care
Organisation: Institut Catala de Salut
City: Valls
Country: Spain
Region: Tarragona
E-mail: ycaules@yahoo.es
Phone: 0034977602000
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