User guidance
 This presentation can be used to train nominal group technique facilitators (slides
can either be projected or distributed in hard-copy)
 The slides can be used to train candidates with no training or experience in
facilitating nominal group meetings (at least one day of training), or to conduct a
refresher course for trained and experienced facilitators (at least a half day
refresher): the content is the same but the pace of work varies
 Train more facilitators than actually required, so as to select the most promising
candidates and compensate for drop-outs. Use functional criteria to select
candidates: e.g. level of education, professional experience and attitudes.
 Deliver this training approximately one week before the meeting but start
preparing it early (rehearse, prepare training materials, etc.)
 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
 Provide further training if necessary
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Nominal group meeting facilitators training pack
<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
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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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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
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)
Preventability
 Harm would not have arisen if
standard levels of care had
been used
or
 An incident is preventable if
reasonable steps to prevent this
occurrence can be identified
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What is a nominal group meeting?
 Why: to understand causes of Harmful
incidents
 What: a meeting aimed at gathering
together the experiences and ideas of
local health care staff through goaloriented brainstorming
 Who:
 the meeting is led by a trained facilitator
 the participants representing all activities
of a health care facility
 How: the facilitator can use talking
points to conduct the meeting
 How long: the meeting requires 1.5 to 2
hours
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Meeting procedure
Introduction
•
•
•
•
•
briefly introduce yourself
conduct an “ice breaker game”, or invite participants to introduce themselves
explain objective: to gather views in order to develop an action plan
purpose is to improve facility’s work, not to test participants
explain that the discussion is confidential
•
explain that an HI is an “unintended injury that results in temporary or
permanent disability, death, prolonged admission or financial loss to the
patient, and which is caused by health care rather than the disease process.”
provide examples of HIs if needed (p. x of method protocol) and answer
questions, but limit discussion to 15’
Define HIs
•
Explain meeting
procedure
Identify HIs
•
•
•
•
•
•
explain the structure of the meeting:
identify HIs observed in this facility
identify contributing problems
identify problems that contribute to several HIs
score problems that contribute to several HIs
agree on the most important contributing problems
•
ask: “What kind of patient harm have you witnessed that was caused by
failure to provide care, by inappropriate or inadequate care being given,
or by care being delivered wrongly?”
ask participants to write down the 2-3 most serious and avoidable HIs on
their sheets and communicate these in turn, with one HI per round (note
these in the “HIs” column)
•
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Meeting procedure (continued)
Identify
contributing
problems
•
ask participants to identify and note on their sheets problems that contribute to
the first HI written on the whiteboard
ask them to communicate their results in turn (note these in the “contributing
factors” column)
proceed in the same way to determine the contributing problems for all HIs
•
•
Identify common
contributing
problems
•
•
•
Score common
contributing
problems
Rank common
contributing
problems
•
•
•
•
•
•
explain that one health care mistake can lead to several HIs
ask participants to identify problems that contribute to several HIs (write
these down in the “problems contributing to several HIs” column)
ask participants to score common contributing problems: scores range from 1
to total number (worst contributing problem receives highest score)
explain criteria: frequency and seriousness of contributing problem,
acceptance and feasibility of solution (most important criterion = cost)
ask participants to communicate their scores (note these in “score” column,
one column per participant)
count score attributed to each common contributing problem
ask participants to discuss the final ranking, so that everybody
agrees
change order of two contributing problems or conduct vote if needed
discuss and note final ranking (in “final ranking” column)
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How to conduct your tasks: do…
 ensure that no meeting has less than 5 or more than 12
participants
 inform participants of the meeting objectives and process,
thoroughly explain the definitions
 inform participants that the objective is to gather their
input and not to test them
 be flexible but follow the suggested meeting procedure
and time plan whenever possible
 find a balance between being too passive (e.g. not
focusing on key questions) and too controlling (e.g.
inhibiting spontaneous participation)
 pay equal attention to all participants and ensure
everybody can freely express himself/herself
 leave participants enough time to think
 listen carefully to what participants say and ask them to
repeat or be more precise if necessary
 speak slowly and use simple language
 ask questions to assess participants' understanding
 use follow-up questions to fully explore each question
 be aware that participants might follow the chorus of
opinions and try to hear their individual views
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How to conduct your tasks: don’t…
 be nervous: there is no reason if you are well prepared
 forget that the primary objective is to assess the situation and not to
teach how things should be done
 waste time on marginal topics
 let the discussion be dominated by a few
 ask embarrassing or unnecessary questions
 pressurize or blame participants
 try to influence participants’ answers or ask ‘leading questions’ (e.g.
‘This is the most important HI, don’t you think?’)
 forget to note participants' answers (in the pre-prepared tables)
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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
1. Participants split into small groups. A facilitator is selected for each
group and the rest of the group act as meeting participants.
2. The facilitator conducts the first phase of the meeting (introduction),
and is then replaced by another facilitator who conducts the second
phase (explaining the meeting procedure), and so forth, for each
phase.
3. The group gives each facilitator feedback and ensures that
everybody has acted as both facilitator and participant.
4. At the end of the exercise, 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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