It can happen anywhere in the world. Maybe you’ve experienced it. Sometimes you can look around a room and feel the energy growing to make big changes.
For me, it happened during a four-day meeting (July 31 – August 3, 2018) in Accra, Ghana, that launched IHI’s Africa Hospital Patient Safety Initiative (AHPSI). AHPSI will be a two-year initiative in 10 hospitals across Ethiopia, Ghana, and South Africa. AHPSI will align with guidance from the World Health Organization (WHO) Global Patient Safety Challenge: Medication Without Harm. Three to four hospitals in each country will participate in a collaborative learning network and use improvement methods to reduce medication harm. The goal is to develop and test context-appropriate actions and compile best practices into a change package that countries can scale up and spread.
This is the first large-scale patient safety project in Africa and the energizing effect of pioneering such a ground-breaking innovation on the continent cannot be underestimated. It was evident from the enthusiasm in the room that represented countries relished the opportunity to create something new that could guide the work of others. IHI has worked closely with many of the people and organizations at the meeting on successful large-scale efforts to improve maternal and child health, so we have a strong improvement foundation upon which to build.
In my view, the launch of this initiative could not have come at a better time. The last decade has ushered in an era in which some countries in Africa are reorienting their health systems to integrate improvement science into transforming health care delivery. While there has been a corresponding increase in understanding of quality improvement (QI), patient safety remains an enigmatic concept for many and few are able to articulate the practical steps for its attainment.
Given the need to demystify patient safety and provide practical tools for implementing and measuring related improvement projects, IHI has made improving patient safety one of our strategic objectives for the region. The initiative began with the design meeting in Accra to develop an operational definition of medication harm and compile an intervention package (with metrics for monitoring progress) that participating hospitals can begin to test later this year.
After touring both a public and private hospital in Ghana and two days of much discussion with a diverse group of 30 health care experts, I came away with the following lessons learned:
View Safety from the Patient’s Perspective — After hearing from health care providers during the site visits, we met with a patient. Clement Asare told us about the multiple times he was harmed — including receiving incorrect diagnoses and developing pressure ulcers — during a series of lengthy hospital admissions after a serious car accident. After twice stopping staff before they gave him the wrong medication, he was labeled “difficult.” His testimony sparked profound introspection among the participants, most of whom were physicians. His story compelled us to define patient safety and medication harm in terms of its impact on patients. It also steered the rest of the meeting towards a focus on patient-centered care.
Agree on Operational Definitions — To focus our collective efforts from the start, we reached consensus on the following aim statement for the initiative: “To reduce (severe) avoidable medication-related harm by 25 percent in the next two years through improved safety knowledge and reliable care processes in 10 hospitals in Ghana, Ethiopia, and South Africa.” In addition, a combined team of patient safety experts from IHI and the WHO agreed that medication-related harm refers to “unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment, or hospitalization, or that results in death.” We also elected to align with the areas the WHO recommends as priorities to prevent patient harm: high-risk situations, polypharmacy, and transitions of care.
Work Together — The meeting was successful in multiple ways. Together, we not only defined medication harm for the initiative and developed a preliminary intervention package, we also injected a new momentum into the patient safety movement in Africa. The practical solutions and tools provided in the intervention package helped participants and their Ministries of Health feel equipped and empowered to make care safer in their respective countries. It was evident that our collective efforts increased will to meet the WHO patient safety challenge.
Given how quickly QI is spreading across health systems in Africa, the launch of this initiative is opportune. The excitement AHPSI participants feel is bolstered by the progress we’ve made in health care in the region in the last 10 years. What we’ve already accomplished gives us both the courage and the knowledge we’ll need to tackle this vital effort to make care safer for millions.
Joe Mando is IHI Director of Operations for Africa.
Learn more about patient safety at the IHI National Forum on Quality Improvement - December 9-12, 2018, in Orlando, FL, USA.