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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
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)
Harmful Incident (HI)
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Key concepts
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
Preventability
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)
Contributing factor
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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 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
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• 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
Introduction
• 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 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)
Identify HIs
Explain meeting
procedure
Meeting procedure
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• 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
Identifycontributing
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)
Identify common
contributingproblems
• 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)
Rank common contributing
problems
Score commoncontributing
problems
Meeting procedure (continued)
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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/