Developing the approach to mapping
Setting the scene
Within the European Union it appears to have been under the Austrian Presidency in 1998 that there was first an agreement between Health Ministers to collaborate on quality in health care. The next major development was the Commission’s new Public Health strategy, published in 2000, which included in the main subsection ‘improving information for the development of public health’ (para. 48), the concept of actively spreading good practice in health care (which would include quality assurance and improvement activities).
However, in 2002, with the initiation of the High Level Reflection Process on Health (HLRP) while David Byrne was Health Commissioner, more focussed interest on health quality became possible.
Previously Article 152 of the Treaty had been seen as proscribing any common approach to health policy matters other than those within a narrowly defined area. Pressure of events began to undermine this imperative, e.g. the implications of citizens (albeit a minority) crossing state frontiers to seek health care outside of their country of origin led to an interest in finding ways of comparing outcomes in a meaningful way. Within the HLRP there were a number of subgroups including one related to patient mobility and one to health quality. Overlapping issues for these two subgroups were – 'do we know what is going on health quality-wise in member states', 'do we have a common vocabulary to allow us to make realistic comparisons', and 'what expert consensus is there on the tools that are deemed effective to measure quality'?
Following the report of the HLRP (end 2003) and the Commission’s response in April 2004, this project on Patient Safety (acronym SIMPatIE) was one of the first quality related multinational projects part-funded by DGSANCO under the ongoing Programme of Community Action in the Field of Public health (2003-2008).
That Patient Safety should be chosen as the topic for such a collaborative project was no coincidence. The concept had been promoted in the USA increasingly since the Institute of Medicine’s publication in 1999 ‘To err is human’ and particularly in the UK (led by the Chief Medical Officer, Dr. Liam Donaldson) with the publication in 2000 of
‘An organisation with a memory’. This led to the setting up in late 2001 of a National Agency for Patient Safety (NPSA) in the UK, with Denmark (where CMO Dr Jens Kristian Gotrik was also influential) following shortly with the establishment of the Danish Society for Patient Safety (DSFP). Patient Safety in Europe had become an area which stimulated considerable interest because successful improvements would result in both substantial cost savings as well as reducing the harm done to patients in the course of their treatment.
Work package development
The Simpatie European mapping exercise was initiated in February 2005 as the first phase of the set of work packages that comprise the programme. The main phases of activity have been:
February – April 2005
Background research and developing an understanding of allied programmes, recruiting the experts’ and reference groups and running an initial reference group workshop to develop the first draft of the research framework.
April – September 2005
Collaboration with WHO Europe leading to a joint symposium in Copenhagen in September 2005, input into development of the Simpatie website and pilot testing the instrument (the questionnaire).
September – November 2005
Refinement of the survey instrument and collection of data against the first five areas of enquiry.
November 2005 – July 2006
Collection of data for the remaining sixteen areas of enquiry.
July 2006 – November 2006
Further collection of data in the interests of ensuring a comprehensive coverage together with verification/validation of the data and start of data analysis. Preliminary consideration of mapping data alongside results of work packages
3, 4, 5 & 6 (Council of Europe recommendations and toolbox results i.e. vocabulary, indicators and tools).
November 2006- December 2006
Collection of good practice examples and entry of data from mapping & good practice exercise onto Simpatie database.
Compatibility of SIMPATIE activities with other European initiatives
A specific aspect of the brief from DGSANCO was to ensure compatibility and minimum overlap with other inter-
national initiatives (as well as relevant projects within DG Research). In this regard it was helpful that there had been involvement by representatives from the project consortium in the OECD patient safety indicator project which was completed in 2003 and that the Council of Europe (whose Committee of Experts on the Management of Safety and Quality in Healthcare had finally reported in early 2005) was also represented on the Simpatie consortium.
In considering the work undertaken by other international programmes, the WHO World Alliance work was seen as very different in nature to others. It had a truly international focus, included participants from all parts of the world. The WHO European office on the other hand had already completed specific work on patient safety in Europe, such as their programmes on blood products. Their officers indicated that they were about to embark on a survey of health ministries to identify the readiness of member states in terms of setting up national patient safety programmes. Colleagues from Simpatie and WHO Europe agreed therefore to mount a joint symposium in September 2005, which was held in Copenhagen at WHO Europe’s headquarters see here and here).
The event included details of the WHO Europe work, the Simpatie programme and various case studies of innovation in patient safety practice. There were workshops to examine particular aspects of both programmes, and the event was a highly useful networking opportunity for the forty colleagues from around twelve countries who attended this symposium, which was written up by WHO Europe as reference material to inform future international and national programmes.
