African Partnerships for Patient safety (APPS): Linking measurement to patient safety action
African Partnerships for Patient Safety (APPS) is building patient safety partnerships between hospitals in Africa and hospitals in Europe. The programme’s three core objectives focus on building patient safety partnerships, supporting patient safety improvements in each partnership hospital, and facilitating the spread of patient safety improvements across each African country. Measurement lies at the heart of each hospital-to-hospital partnership.
The APPS approach to improving patient safety begins with the establishment of a patient safety partnership between two hospitals. APPS bases its activities on clearly understanding the unique needs of each hospital partnership. As a first step, hospitals establish the patient safety situation by using the APPS Situational Analysis Template, covering each of the 12 patient safety action areas agreed by countries in the WHO African Region. The results of the analysis are used to determine the baseline, identify gaps and decide on priorities for action. Once priorities are agreed, an action plan is developed and action taken across the partnership.
The situational analysis template has been used by APPS hospitals to provide a baseline snapshot of patient safety in each of the six APPS hospitals in Africa (Cameroon, Ethiopia, Malawi, Mali, Senegal and Uganda) .Ultimately, the template will be available to any hospital wishing to understand patient safety issues in their institution, whether in Africa, Europe, or beyond.
APPS has also developed an evaluation framework. The partnerships themselves contributed heavily to framework development, providing contextual awareness – simplicity was the guiding principle. Indicators for each of the three core objectives were identified, scrutinized and refined. Capture tools were sourced or developed. Available tools on health care-associated infections (the common platform of working across the partnerships) were incorporated into the framework.
The evaluation framework that emerged captures each of the three objectives. Six domains of partnership strength (with associated facets for each domain) form the basis of evaluating this first core objective. A “3-2-1” approach emerged in evaluating hospital patient safety improvement focused on health care-associated infection (3 structure; 2 process; 1 outcome indicator). An initial 20 measures of patient safety spread fell into two broad categories (initial spread activities & ongoing relationships). In addition, periodic repeat situational analyses can assess progress in achieving patient safety improvements in participating hospitals.
Each of the six first wave partnerships are now using the framework, as well as repeating situational analyses – findings will be synthesized later this year. These early APPS experiences can guide continuous refinement of activities at the hospital partnership level, as well as refinement of the overall APPS approach to measurement and evaluation.
There is a significant paucity of patient safety data from African institutions. The APPS approach allows measurement to be clearly linked to action – fundamental change in health systems can only be achieved through such a clear link. Measurement is impotent without action!