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 1

Nominal group meeting facilitators training pack

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What and how will you learn?

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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 3

What is patient safety?

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Freedom from accidental injuries during medical care

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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 hospitalization, spent loss disability and litigation on of prolonged income, 5

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 6

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) 7

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 co ordination 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 8

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 goal oriented 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 9

Meeting procedure

Introduction Define HIs Explain meeting procedure Identify HIs

• • • • • 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’ 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) 10

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

• • 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)

Score common contributing problems Rank common contributing problems

• • • • • • • 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) 11

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 12

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) 13

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 15

Hands-on exercise

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Participants split into small groups. A facilitator is selected for each group and the rest of the group act as meeting participants. 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. The group gives each facilitator feedback and ensures that everybody has acted as both facilitator and participant.

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. 16

Further information

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For further information, questions or comments contact

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Visit the Patient Safety Programme (Research) website at: http://www.who.int/patientsafety/research/en/

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