User guidance
 This presentation can be used to train nominal group technique facilitators (slides
can either be projected or distributed in hard-copy)
 Train more facilitators than actually required, so as to select the most promising
candidates and compensate for drop-outs.
 Deliver this training approximately one week before the meeting but start
preparing it early (rehearse, prepare training materials, etc.)
 A minimum timeframe of x hours is required to complete this training session

The slides can be used to train interviewers with no training or experience
(approximately x days/hours), or for a refresher course for trained and experienced
interviewers (approximately x days/hours): the content is the same but the pace of work
varies.
 Adapt the slides to local requirements if needed
 Distribute a method protocol to each participant at the beginning of the session
 Speak slowly and clearly, avoid creating a ‘teacher-student’ impression,
encourage discussion, and ask questions to ensure optimal understanding
 Ask questions to assess participants’ understanding
 Provide further training if necessary
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Slides to train observers and interviewers
<insert your name, position and affiliation>
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What and how will you learn?
What:
 Patient safety and WHO's initiative
 Key concepts of patient safety
 The objectives and processes of nominal
group meetings
 Your role as a meeting facilitator
 How to excel in your role: do's and don'ts
How:
 Facilitator-led presentation
 Questions and discussions
 Quiz
 Hands-on exercise
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What is patient safety?
 Freedom from accidental
injuries during medical care
 Activities to avoid, prevent
or correct any adverse
outcomes which may result
from the delivery of health
care
4
Why is patient safety important?
 Every year tens of millions of patients
suffer disabling injuries or death due to
unsafe medical care
 In developed countries 1 in 10 patients
is harmed while receiving hospital care
 We know little for developing countries
but evidence suggests that they are
even more affected by patient harm
 The consequences are millions of
devastated lives and billions of dollars
unnecessarily spent on prolonged
hospitalization,
loss
of
income,
disability and litigation
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The initiative of the World Health Organization
 Against this backdrop, the World Health
Organization called into life the World Alliance
for Patient Safety in 2004
 The Alliance pays particular attention to patient
harm in developing and transitional countries
 Since fact-based knowledge is often rare in
such contexts, the Alliance has developed
simple methods to help local practitioners and
researchers assess and tackle patient harm in
data-poor environments
 You can contribute to successfully conducting
one of these methods by acting as a nominal
group meeting facilitator
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What is direct observation?
 Why: either to identify causes of HIs occurring
during injection giving/problems relating to injection
facilities and supply stock, or to monitor and
improve achievements
 What: observation of injection facilities and
supply stock, and of injection practices
Who: observation is conducted by trained
observers
How: observers use questionnaires to guide
observation, and results tables to condense results
 How long: thee investigators need half a day to
conduct direct observation and interviews for five
wards/departments of a district hospital
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What are interviews?






Why: either to identify problems relating to
injection practices/injection facilities and
supply stock, or to monitor and improve
achievements
What: interviews with injection givers and
their department supervisors
Who: interviews are conducted by trained
interviewers
How: interviewers use questionnaires to
guide the interviews, and results tables to
condense results
How long: thee investigators need half a
day to conduct direct observation and
interviews for five wards/departments of a
district hospital
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Your role: prepare observation/interviews*
1. Principal investigator only
 studies method protocol, questionnaires and
key success factors
 presents project objective to facility
anagers/stakeholders, receives approval and
explains how they can support the project

agrees with facility managers on which
wards/units will be assessed and when
selects and trains observers and interviewers
2. All investigators
 study method protocol, questionnaires and
key success factors

prepare to explain and conduct the
observation/interviews

clarify questions and make necessary
arrangements (availability of staff,
questionnaires, etc.)
* More comprehensive guidance is provided in the method protocol
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Your role: conduct of observation/interviews*
3. Introduction
 present objective of assessment to matron, explain how she
can help, be introduced to staff from participating clinical
areas, and help her explain that:

no disciplinary measures will be taken against staff if unsafe
injection practices are discovered

names are not recorded on the data collection sheets

staff have the right to refuse participation

objective is to improve healthcare provision, not to assess
observed individuals
4. Fill in questionnaires and results tables

observers complete a questionnaire based on observation of
facilities and stock (questionnaire 1) and one on injection
practices (questionnaire 2)

interviewers complete a questionnaire based on interviews
with healthcare workers (3.a) and one based on interviews
with department supervisors (3.b)

team fills in results tables based on information contained in
questionnaires
*More comprehensive guidance is provided in the method protocol
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Your role: conduct of observation/interviews*
(continued)
5. Compare results tables of the current assessment to
those of past assessments (if the objective is to
monitor and improve the results of previous
assessments only)
 if same wards have been analysed: discuss with
department supervisor so as to identify in which areas
progress has/has not been achieved, and for what reasons
 If different units have been analysed: discuss with
department supervisor so as to identify whether observed
HI problems relating to injection facilities and supply stock
are the same or differ
 Agree with department supervisor on improvement
measures and when/how to re-assess the situation
6. Conclude Observations/interviews
 ensure that questionnaires/results tables are fully and
clearly completed •
 thank involved staff, explain next steps, provide contact
details and present results to facility managers if possible
*More comprehensive guidance is provided in the method protocol
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How to excel in role as an observer: do…








discuss with the principal investigator any parts of
the questionnaire you are unclear about
observe closely and note as precisely as possible,
and only once the care-giver has finished an action
put yourself in an open frame of mind, so that your
observations are as free of opinions and bias as
possible
be aware that observed care-givers may perform
their work differently or better when being observed
try to reduce the stress that observation places on
observed care-givers
stop observing if a care-giver does not wish to
continue the assessment
answer questions that observed staff may raise at
the end of the observation (unless this could
expose an injection recipient to risks)
focus on what is asked in the questionnaire, rather
than writing down everything you notice
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How to excel in role as an observer: don't…





forget that the primary objective is to assess the
situation and not to teach staff how to do things
forget to refrain as much as possible from
interacting with a care-giver, but do interrupt
him/her if he/she is about to expose an injection
recipient to substantial risks
draw attention to your observer role; to avoid
influencing the environment you observe be as
discreet as possible
let your note taking get in the way of observing
what nurses are doing: first observe, then take
notes
wait to clean up and complete your notes after the
observation, or you will forget information
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How to excel in your role as an interviewer:
do...
 discuss with the principal investigator any parts of the questionnaire
you are unclear about
 conduct the interviews in a calm environment and avoid interruptions

allow time to build a relationship of trust with the respondent

inform respondents that the objective is to improve injection practices
and availability of equipment, and not to test individual care-givers

follow the questionnaire as much as possible, but provide further
explanations if needed

speak slowly and use understandable language

leave respondents enough time to think
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How to excel in your role as an interviewer:
don’t...
 be nervous: the respondent is probably more nervous than you

forget that the primary objective is to assess the situation and not to
teach staff how to do things

pressurize respondents or try to influence their answers

ask ‘leading questions’ (e.g. ‘You changed the steriliser safety valve
last month, didn’t you?’)

ask embarrassing or unnecessary questions

conduct the interview in the presence of respondents’ colleagues,
whenever possible (social desirability bias)

let your note taking get in the way of listening to the respondent: first
listen, then take notes

wait to clean up and complete your notes after the interview, or you
will forget information
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Questions? Comments?
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Quiz
Instructions
 Not a pass/fail test but an opportunity to identify areas that require further
discussion or training
 Participants discuss the questions in small groups (you can use your method
protocol), followed by each group presenting its answers and a general
discussion led by the facilitator and aimed at clarifying potential questions
Questions
 Explain the concepts of patient safety, HIs, preventability and contributing
factors in your own words and give examples for each
 Summarize the objective and process of a nominal group technique meeting
 Describe the tasks you will be performing step-by-step
 Discuss how to best ensure that the do‘s and don‘ts are respected
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Hands-on exercise
simulation of direct observation
1. Participants split into small groups. One participant in each group
simulates the injection giver (trainer provides the necessary
equipment or injection giver orally explains every step he would
conduct), and other group members observe and take notes (based
on questionnaire).
2. Participants change roles so that everybody acts both as injection
giver and as observer. Once all observation-based questionnaires
are completed, the team fills in the results tables together.
3. The trainer animates a discussion on the results, problems and
lessons learned, and answers any questions participants might
have
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Hands-on exercise:
simulation of an interview
1.
1. Participants split into small groups. In each group, one participant acts as
interviewer, another as respondent, and the rest of the group observes the
role-play. The interviewer asks questions (based on the questionnaire) and
the respondent answers these.
2.
2. Participants change roles so that everybody has acted as interviewer and
as respondent. Once all interview-based questionnaires are completed, the
team fills in the results tables together.
3.
3. The animates a discussion on the results, problems and lessons learned
and answers any questions participants might have
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Further information
 For further information, questions or comments contact
<insert your name and telephone number or email>
 Visit the Patient Safety Programme (Research) website at:
http://www.who.int/patientsafety/research/en/
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