the apps approach - who · the ace approach (apps community engagement approach) has 7-steps. each...
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African Partnerships for Patient Safety (APPS)
Engaging Communities: making it real
APPS Community Engagement Implementation Pack
The APPS Approach
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Contents
Purpose and Scope 3
How can the ACE Approach integrate within 4 the APPS Programme Cycle? General Lessons on implementing ACE 5
Step 1: Know the Community 6
Step 2: Establish an Enabling Community Engagement 7 Environment Step 3: Raise Patient Safety Awareness – locally and nationally 8 Step 4: Collect Community Knowledge and Experiences 9 Step 5: Ensure Robust Communication Mechanisms 10 Step 6: Feed into Monitoring and Evaluation 11 Step 7: Develop a Community Ripple Effect 12
Annex 1: APPS 6 Step Programme Cycle and the 14
ACE Approach Visual
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Purpose and Scope
African Partnerships for Patient Safety (APPS) considers community engagement as an
important aspect of hospital patient safety improvement. This document provides APPS
hospitals with systematic assistance in developing and maintaining community engagement
mechanisms.
The ACE Approach (APPS Community Engagement Approach) has 7-steps. Each step is
considered in turn with the following information:
Summary of the ACE step
Overview of how the ACE step sits within the APPS 6-Step improvement cycle
How the step is reflected in the APPS Patient Safety Situational Analysis tool,,
outlining specific related questions
Examples of activities undertaken by current APPS Partnership Hospitals
Questions to prompt further ideas and developments to support designing and
planning community engagement activities
APPS Project Structures: Overview
Seven Steps of the ACE Approach
1. Know the Community 2. Establish an Enabling Community
Engagement Environment 3. Raise Patient Safety Awareness -
locally and nationally 4. Collect Community Knowledge and
Experiences 5. Ensure Robust Communication
Mechanisms 6. Feed into Monitoring and Evaluation 7. Develop a Community Ripple Effect
APPS 6-Step Cycle for Patient Safety Improvement
Partners work together to establish the patient safety baseline in their respective hospital using a patient safety situational analysis tool. Results of the analysis are examined to identify gaps which might contribute to patient harm and priorities for action agreed. An action plan is developed with the involvement of both partner hospitals, and action is taken to address the patient safety gaps. A review and evaluation cycle is built in.
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How the ACE Approach integrates within the APPS Cycle
As the diagram above shows, the ACE approach weaves its way through the activities
during the 6 step APPS cycle, running alongside each step of the APPS process. Some of
the same ACE activities appear in more than one step. The diagram illustrates a
mechanism to use in your planning and is not meant to represent an exclusive process.
Each step and overlap of the two processes should be treated with fluidity and flexibility,
tailored to specific circumstances and environments.
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General Lessons on Implementing ACE
Several key lessons have been shared from current APPS hospital-to-hospital partnerships
on establishing effective community engagement mechanisms to support their patient safety
efforts. These provide a basis on which to frame efforts you are planning on community
engagement within your partnership work.
1. Include community engagement from the beginning of your partnership work in
patient safety. It is ideally not an “add on” for later down the line but should be
planned and acted on from the launch of the APPS focussed partnership working.
Mobilization of communities and sensitization of partners and health care workers is
essential from the start.
2. Communities need to be empowered and understand their rights and responsibilities
so they can ‘demand’ better services and have the confidence to promote and remind
health care workers to wash their hands.
3. “Patient Guardians” have a unique role and are critical in the response to
overburdened health work force. As critical carer givers for patients in daily living
activities, they can be key partners in patient safety improvement.
4. Acknowledgement that there is a scarcity of human and financial resources for
community engagement activities making it essential to weave it into partnership
activity planning.
5. Community engagement has more momentum and is seen as strengthening the
technical elements of patient safety improvements being undertaken.
6. It is never too late. Some partnerships utilized community engagement mechanisms
after establishing a basis for patient safety in the hospital. While this was not
considered ideal, this step-wise approach worked for some partnerships.
Feedback from ministries of health from countries with an APPS partnership has also
provided some useful foundations on which Community Engagement can support on-going
patient safety work. 75% of ministries who participated in a recent survey stated that
national policy on patients’ rights and responsibilities had changed over the last two years
and 75% of them were aware of patient groups active on the national level who were
campaigning for improvements in health care quality, access to health care and changes to
national health policy. This national context provides a clear place to start, both for mapping
key players to engage with, and in terms of developing effective community engagement at
the local level building on the national frameworks and mechanisms already in place around
rights and involvement.
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STEP 1: Know the Community
*see full visual above in Annex 1.
Step Summary:
Map the local key players
Map existing organizations and mechanisms for community partnerships that could add value to the development and design of the APPS hospital partnership plan
Identify community perspectives on patient safety and medical harm
Identify the role of the family and the household in providing safe care
Things to consider:
Who are the key players in the local community and who should be involved with APPS in
order to ensure effective community involvement?
Does the hospital have any existing links with civil society and community that can be
utilized in order to better understand community perspectives on the hospital and the
safety of their care?
Examples of activity:
COU Kisiizi Hospital, Uganda undertook a mapping
exercise to establish what mechanisms already existed
in the hospital where patient safety messaging could be
included to educate the local community on the APPS
work and patient safety issues in particular. Listing all
the outreach clinics, local social groups, the reach of the
health insurance scheme run by the hospital were all
mapped as opportunities, along with the role of the
hospital within the community such as having a primary
school and church on the same site.
In Kamuzu Referral Hospital, Malawi, using the
community to connect with the district level health
institutions was critical. As a central referral hospital
they did not have the mandate to work directly with the
community or necessarily the right mechanisms. They
undertook district level health briefings on patient safety
and used structures such as disease surveillance and
cholera outbreak committees to spread patient safety
awareness and messages.
Patient Safety Situational
Analysis:
Relevant Questions
Section IV
Q10. Does the hospital have any links
with civil society and community that can
be utilized for increasing awareness of
patient safety?
Section X
Q8. Does the hospital have any
outreach programmes working in the
community?
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STEP 2: Establish an Enabling Community Engagement
Environment
*see full visual above in Annex 1.
Step Summary:
Create buy-in, commitment and understanding within the hospital
Facilitate and support community members to participate in meetings, consultations and reviews
Foster emergence of dynamic community leaders who can champion messages
Have clear jointly agreed vision of the engagement process and a common agenda with roles and responsibilities
Things to consider:
Are there any national patient organizations or consumer associations that would be
interested in being involved?
How can you share with other hospital leaders and staff the importance of engaging with,
talking to and valuing patients, family members and local community?
How can you support community representatives to be involved – do they need a one to
one briefings, extra support with literacy, support to attend meetings? 7
Examples of activity:
Hospital Fann, Senegal has connected with the local
community and now has two community representatives
on the APPS Advisory Board at the hospital.
In Kamuzu Referral Hospital, Malawi, two
representatives from national patient and consumer
organizations are on the APPS Board within the
hospital. They have also invited guardians to join
department meetings at regular intervals. Lessons can
flow both ways about perspectives on care. Patient
safety messages that can go home and be shared with
family and friends, for example on effective hand
washing and asking doctors questions when something
is unclear.
Patient Safety Situational Analysis:
Relevant Questions
Section IV
Q5. Are there any mechanisms in place to
sensitize health professionals on the
necessity and means through which patients
and community can be engaged on patient
safety issues?
Section X
Q1 Has the hospital involved patients and
community in priority setting, service planning
and patient safety improvement?
Q5. Does the hospital have a committee to
plan and develop partnerships between
patients/families?
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STEP 3: Raise Patient Safety Awareness – locally and nationally
*see full visual above in Annex 1.
Step Summary:
Feed into existing health campaigns and programmes with patient safety knowledge
Construct education and training mechanisms for patient safety awareness
Promote, advocate for and influence patient safety policy development at all levels
Use community mechanisms to promote understanding of patient safety at the grassroots.
Things to consider:
What are the key events in the coming year
where you can raise awareness of patient
safety within the community e.g. Hand
Hygiene Day (5 May), Global Handwashing
Day (15 October), Patient Solidarity Day (30
October)
Can you access local media to relay
messages that support patient safety activities
at the hospital?
How could you support local patient
champions to conduct campaigns and
education programmes on patient safety which
will in-still confidence, adherence and
sustainability of the partnership work?
Examples of activity:
In COU Kisiizi Hospital, Uganda several outreach
clinics which had been identified as relevant mechanisms
provided good awareness raising opportunities, including
groups for the elderly and providing lessons to local
primary school children on the importance of hand
washing. As a faith based hospital they also undertook
demonstrations on hand hygiene to the community through
church services. At their launch of the APPS programme a
local song and dance group created and performed a song
on the importance of hand washing and patient safety.
In Kamuzu Referral Hospital, Malawi, they undertook
a hand hygiene and infection prevention and control
awareness event at the local market, carried out
knowledge sharing on patient safety with patients, families
and guardians through morning meetings at the hospital
entrance and are collaborating with several of their clinics
on safety issues eg. Compliance to long term therapy for
HIV/Aids and diabetes clinics, antenatal education and
under 5’s clinic for the education for nutritional feeding
programme. The hospital also has a series of posters
sharing information about patients’ rights.
In Gondar University Hospital, Ethiopia, they ran a
poster campaign with local school children on hand
washing and what hand washing meant to them. The two
winning designs have now been turned into reminder
posters for health care staff, patients and families around
the hospital.
Patient Safety Situational Analysis:
Relevant Questions
Section IV
Q2. In the last year has the hospital
participated in any community focussed
activities to raise awareness?
Q3. Are there any mechanisms within the
hospital to inform patients of their rights?
Q7. Any mechanisms for informing patients
and families about patient safety?
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Step 4: Collect Community Knowledge and Experiences
*see full visual above in Annex 1.
Things to consider:
How well do staff understand the perspective of patients, families and communities who
enter the hospital – fears, understanding of the system, experiences of care?
APPS can provide support in developing a set of questions to collect experiences even
when it may be sensitive or difficult.
Examples of activity:
In Gondar University Hospital, Ethiopia, with
their Hospital partner support, lead nursing staff took
time to walk through the hospital and ‘interview’
patients and families about their experiences of the
service they had received and also their thoughts on
the quality of the care they had either received or
witnessed. The experience was hugely informative
for the staff to really see things from the patient
perspective and better understand their concerns and
fears. The patients and families appreciated being
listened to and being able to speak out. The plan is to
make this a more regular activity to collect
experience and learning that can feed into APPS
planning and activity.
Patient Safety Situational Analysis:
Relevant Questions
Section IV
Q9. Are there any mechanisms for patients
and health professionals to share ideas and
concerns?
Step Summary:
Take opportunities to collect personal experiences of medical harm, patient safety and health care experiences to support dissemination of learning
Develop case studies for education, training and initiative development
Document and capture engagement process so others can learn in the future
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STEP 5: Ensure Robust Communication Mechanisms
*see full visual above in Annex 1.
Step Summary:
Design and develop communication and education materials in collaboration with those for whom it is intended
Ensure effective channels of communication between community members, patients and families and the hospital
Work with media to support positive coverage of patient safety messages
Things to consider:
Invite community members and patients to be involved in creating effective materials for
communication – they’ll know what works for them best! If illiteracy is an issue can
messages be shared visually?
Do your community members have some where specific to go to voice their perspectives
and concerns? Do they know how to access that?
Examples of activity:
Hospital Fann, Senegal has worked with local radio
to open up communication with the surrounding
community on patient safety issues.
Kamuzu Referral Hospital, Malawi, has patient
suggestion boxes around the hospital so ideas can be
shared. Patients can also call the hospital leaders
directly with any concerns or complaints and the
numbers are displayed on notice boards in waiting
areas. Guardians are invited to department and ward
meetings to have open dialogue. Meetings are held in
waiting areas and by the hospital entrance to provide a
mechanism for voices to be heard.
Patient Safety Situational Analysis:
Relevant Questions
Section IV
Q6. Is there a system to obtain patient
consent before procedures?
Section X
Q3. Has a survey been undertaken on the
way information is handled between health
professionals and patients/families?
Q4 Is there a designated member of staff
responsible for patient complaints?
Q6. Does the hospital have regular meetings
with key local community/civil society players
to interface and exchange concerns?
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STEP 6: Feed into Monitoring and Evaluation
*see full visual above in Annex 1.
Step Summary:
Develop mechanisms for community feedback to contribute to monitoring and evaluation of APPS activities
Use community members to monitor and evaluate and hold to account patient safety initiatives
Things to consider:
Patients and families see things that busy health care professionals may not. Think how
you could capture this to feed into the APPS evaluation and monitoring process.
A community perspective and evaluation of the APPS activities can provide valuable
perspectives to strengthen programme development.
Examples of activity:
In Kamuzu Referral Hospital, Malawi, an
evaluation mechanism includes patient guardian
contributions to hand hygiene compliance monitoring.
The intent is to include patients and their families in a
partnership to monitor and drive patient safety action.
Patient Safety Situational Analysis:
Relevant Questions
Section X
Q2. Are there any mechanisms in use for
involving patients and community members in
feedback?
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STEP 7: Develop a Community Ripple Effect
*see full visual above in Annex 1.
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Step Summary:
Create a network of community stakeholders
Where possible work through formal partnerships with established community organizations to disseminate learning nationally
Ensure APPS community engagement mechanisms are in alignment with national policies and strategies on community engagement
Use APPS community engagement to enhance an integrated health care system approach from hospital to district.
Things to consider:
Is there a national patient charter that can be promoted or used as a baseline for activity?
Is there an opportunity to invite a national patient or community representative to speak at
a Hospital patient safety event?
Is there a patient or community network that can provide feedback on your APPS plan of
activities to see how they could support your efforts?
Examples of activity:
In Kamuzu Referral Hospital, Malawi the hospital
is working closely with the Consumer Association of
Malawi and the Malawi Health Equity Network. Both
have representation on the Hospital APPS Board and
have the reach of the national networks for sharing
lessons and information on patient safety. They have
also managed to use the patient safety improvement
work to connect with the district level health centres.
In Gondar University Hospital, Ethiopia the
national Patient Safety Charter is displayed at the
Hospital entrance.
In COU Kisiizi Hospital, Uganda, work with a
national patients’ rights organization and their efforts
with the Ministry of Health to create a Patient Charter
forms the basis for on-going discussions on potential
community activity to promote better quality of care
nationally. The importance of community engagement
was shared during a sensitization workshop held by the
hospital with representatives from all hospitals and
health clinics in the two neighbouring districts, who
came to learn about APPS and implementation.
Patient Safety Situational Analysis:
Relevant Questions
Section IV
Q1. Does a Patient Safety Rights Declaration
or Charter exist?
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For further information or if you would like to share your experience of using this
resource please contact us on [email protected]
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