User guidance
 This presentation can be used to train investigators conducting interviews with current
in-patients (slides can either be projected or distributed in hard-copy)
 Train more investigators than required for the study so as to select the most promising
candidates and compensate for drop-outs
 Deliver this training approximately one week before the interviews 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 investigators with no training or experience (one to two
days of training), or for a refresher course for trained and experienced interviewers (half
to one day refresher): the content is the same but the pace of work varies
 Adapt the slides in line with local requirements, as appropriate
 Distribute a copy of the method protocol and the RF2 form to each participant at the
beginning of the session
 Speak slowly and clearly and encourage discussion to ensure optimal understanding
 Ask questions to assess participants’ understanding
 Provide further training if necessary
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Slides to train investigators conducting staff
interviews on current in-patients
<insert your name, title and affiliation>
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What and how will you learn?
What:
 Patient safety and the WHO initiative
 Key concepts of patient safety
 The objective and process of a staff
interview
 Your role as an interviewer
 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
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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 are staff interviews on current in-patients?
 What: a trained interviewer asks local
care givers (nurse and doctor/physician
in charge of in-patients) questions on
local in-patients and sscreening of
relevant documents (if available)
 Why: either to estimate the prevalence
of harmful incidents and understand
their causes or to monitor and improve
patient safety achievements
 How: the interviewer uses harmful
incidents detection criteria and a
questionnaire
 How long: interviewing local staff for a
30-bed ward requires approximately
one day
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Key concepts
Harmful Incident (HI)
 Unintended injury or
complication
 Prolonged admission, disability
at discharge or death
 Caused by health-care
management rather than the
disease process
 May or may not be preventable
or caused by negligence (e.g.
post-operation wound infection)
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Key concepts
Prevalence of HIs
 the ratio on the day of data
collection of the number of
cases with HIs to the total
number of cases:
number of HIs x 100
number of screened records
Preventability
 Harm would not have arisen if
standard levels of care had
been used
or
 Incident is preventable if
reasonable steps to prevent this
occurrence can be identified
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Key concepts
In-patient
 Patient admitted to a healthcare facility for treatment that
requires at least one overnight
stay
Contributing factor
 A factor in an event, effect, result or
outcome which is similar to a cause
and can relate to the
 Patient (e.g. co-morbidities)
 Task (e.g. lack of
guidelines/protocols or their
use)
 Individual (e.g. lack of
knowledge)
 Team (e.g. poor team-work)
 Environment (e.g. defective or
unavailable equipment)
 Organisation (e.g. poor coordination of overall services)
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The process of staff interviews
Phase
Interviews with nurse
Interview with doctor/physician
Specifications
 Why to: select cases with high
likelihood of HIs and reduce
number of cases that need to be
discussed with doctor/physician
 Why: to closely examine in-patient
cases that have been earmarked
as ‘high-risk’ cases
 What: interview nurse
supervisor/ward nurse and
screen any available documents
(at the least, the admission notes
and discharge summary, if
available)
 How: based on detection criteria
provided in method protocol
 How long: x hours for x patient
cases
 What: interview doctor/physician
and screen any available
documents for evidence of HIs,
preventability, contributing factors
and nature of HIs, among other
issues
 How: based on a comprehensive
questionnaire (RF2)
 How long: x hours for x patient
cases
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Your role: overview of tasks*
1. Before the interview: prepare to explain and conduct the interviews and
arrange meeting room and materials
2. Upon arrival at the health-care facility: be introduced to supervisor/ward
nurse and doctor/physician, reassure them of confidentiality, explain
objective and procedure of staff interviews and provide definition of HIs
3. Write list of names and gather available records
4. Interview nurse and examine records for specific criteria (p. x of method
protocol)
5. Complete RF2 form for each ‘high-risk’ case, ensure forms are completed
as fully as possible and destroy list of names and first pages of RF2 forms
6. Calculate incidence of HIs and compare results to those of previous
assessments (only if the objective is to monitor and improve past patient
safety achievements)
7. Return all records, explain next steps, thank involved staff and present
results to facility managers
* more comprehensive guidance is provided in the method protocol
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How to excel in your role: do…
 discuss with the principal investigator any parts
of the RF2 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
examine cases of in-patients and not to test
them
 follow the detection criteria and the RF2
questionnaire as much as possible but provide
further explanations if needed
 speak slowly and use understandable language
 leave respondents enough time to think
 use follow-up questions until a question is
clarified or can definitely not be answered
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How to excel in your role: 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
 conduct the interview in presence of
respondents’ colleagues whenever possible
(social desirability bias)
 pressurize respondents or try to influence their
answers
 ask ‘leading questions’ (e.g. ‘This HI wasn’t
preventable, don’t you think?’)
 ask embarrassing or unnecessary questions
 let your note-taking get in the way of listening to
the respondent: first listen, then take notes
 wait before cleaning up and completing your
notes 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 each question in small groups (you can use your method
protocol), followed by each group presenting its answers and by a general discussion
led by the facilitator, who clarifies any unanswered 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 staff interviews
•
Describe the tasks you will be performing step-by-step
•
Discuss how you can best ensure that the do‘s and don’ts are respected
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Hands-on exercise
1.
Participants split into small groups to simulate
interviews. An interviewer and a nurse/doctor are
selected for each group, the rest of the group watches.
2.
The interviewer interviews the nurse and consults sample medical records
(provided by the trainer) to determine for each case whether HIs are
present or not (based on detection criteria).
3.
For all positively screened cases, the interviewer completes the RF2 form
based on an interview with the doctor (and possibly medical records).
4.
At the end of each interview, those group members who have watched the
simulation give feedback on the strengths and weakness of the simulation.
As many participants as possible act as interviewers and nurses/doctors.
5.
At the end of the simulation session, each group explains the problems
they have faced and the lessons they have learned. The trainer clarifies
potential questions.
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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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