Section I. 1Annex 1b

Content, methods and work schedule

The healthcare sector continuously produces innovative solutions directly deriving from experience of professionals who face the problem of enhancing PS in different scenarios. As a matter of fact, the diffusion of innovation in healthcare is difficult and when it does happen it is typically slow. Strategies need to be implemented to overcome obstacles preventing the translation from best evidence to best practices.

A dynamic interactive step-wise working process will be initiated around the four main tasks outlined below. Each task is lead by the TL and carried out in a task group; sub tasks are decided within the task group. Interaction between the groups takes place partly due to overlap in partners participating in the groups, partly in coordination of the task through the TLs.

Below is a short description on each task and how it relates to the objective and the final delivery of WP4. This description is followed by in depth specification of content and method of work for the WP.

1. 
   Review and establishment of a glossary and a conceptual framework will be the common starting point of the WP4 work, and the base of the further work, contributing to the final delivery. The conceptual framework will be established in cooperation with WP6.
   
2. 
   Data collection: identifying and describing safe clinical practices is one of the core tasks of the WP, relating directly to the objective. Safe clinical practices already in place in MS are to be identified, described by MS in a form developed for the purpose, and after approval by the JA governance structure presented on the web tool. Solving this task leads to the WP delivery: “A report of good clinical practice solutions in PS.”
   
3. 
   Defining concepts for exchange mechanisms and developing implementation support tools is also one of the core tasks of WP4, relating directly to the objective. WP4 will suggest themes and forms of the exchange mechanisms based upon the data collection described above. Part of the philosophy which lies behind the exchange mechanisms is: “See One, Do One, Teach One”.
   
4. 
   Sharing SCP through an interactive web tool is also one of the core tasks of the WP, relating directly to the objective. WP4 is to define the content for the web tool, which is developed by WP2.
   
5. 
   Feasibility analysis and action plan for the remaining project period. This is an activity and a milestone to ensure both meeting MS needs and a well balanced use of resources for the remaining project period especially in regard to the implementation of the exchange mechanisms.
   
6. 
   Implementation: sharing of SCP through exchange mechanisms. The organisation of the exchange will be under the responsibility of WP1, and organised in coordination with the NCPs.
   

WP4 is focused upon safe clinical practices at the clinical level, whereas WP6 is focused upon PS and quality improvement systems in place in the MS (system level).

We strive to develop a framework in cooperation between the core WPs. Also we strive to define some common areas of PS to work further with across WP4 and 6. Themes could be: patient involvement, hand-hygiene, fall prevention, infection control or reporting of adverse events. The important thing is that the common themes must hold information on both national strategies and policies (Applicable for WP6) and local SCP (Applicable for WP4).

Task specification and method of work

1. 
   Review and establishment of a supplementing glossary and a conceptual framework
   

The glossary is designed to define/describe terms and concepts used in the further work of the WP, aiding the understanding and development of the framework for the SCP. The glossary will supplement other relevant terminologies/glossaries/classifications/typologies already established e.g. by SimPatIE, LINNEAUS, and by WHO. In this way we will not seek to redefine terms already well established.

It is foreseen that primary terms like “safe clinical practices”, and “exchange mechanism” will be defined and also specified by sub terms, e.g. Exchange mechanism is a primary term comprising sub terms like “study tours”, “workshops”, “twinning”. In the glossary each primary and sub term will be described comprehensively according to its use in WP4.

The conceptual framework will be designed to provide the needed method for collecting and organising SCP data and information so that it can be aggregated and exposed on the web tool. Via the framework the SCP must be stratified in main and sub topics e.g.

• 
  patient safety methods
  
  • 
    organising PS work at the clinical level; including e.g. management, education
    
  • 
    identification and assessment of risk or harm
    
  • 
    reporting and learning systems
    
  • 
    analysis and learning
    
  • 
    surveillance of successful implementation & results
    
• 
  preventive interventions
  
  • 
    infection control
    
  • 
    surgical practice
    
  • 
    medication safety
    
  • 
    safety of medical devices
    
  • 
    prevention of falls and fall-related injuries
    
  • 
    safe communication
    
  • 
    patient involvement
    
  • 
    establishing a safe PS culture.
    

The framework could be based upon the “A framework for classifying PS practices: results from an expert consensus process” by Sydney M Dy et al. BMJ Qual Saf 2011;20:618-624.

Process expected to be accomplished is:

• 
  all partners of the WP will be invited to suggest terms they find appropriate for the WP4 work. This will happen at the initial Kick-off meeting in a brainstorm session, introduced by the WP Leader
  
• 
  the task group will stratify the terms, and perform a literature search identifying possible definition of the suggested terms
  
• 
  based upon the literature search and input from the task group, definitions for terms will be suggested and finally approved by all partners in the WP
  
• 
  possible areas of the SCP will be identified, based upon feed-in from the partners. Likewise this will happen in the initial Kick-off meeting in a brainstorm session, introduced by the WP Leader
  
• 
  a literature search will be performed to identify existing frameworks suitable for describing the concept and organising SCP
  
• 
  based upon the input from the partners and the literature search a conceptual framework will be drafted
  
• 
  the glossary and the conceptual framework can be subjected to supplements and changes throughout the project if the further work shows this to be necessary.
  
• 
  presentation of the framework in cooperation with WP6 at M6
  

2. 
   Data collection: identifying and describing safe clinical practices and MS needs
   

The SCP may address different topics, specialities, professions, and settings as outlined in the framework. E.g. SCP for infection control in a general practice might be different to the ones used in a dental clinic, an intensive care unit, or on a psychiatric ward. It will be equally important to collect SCP for these settings, and for different specialities. Likewise different methods of analysing risk or harm to patients might be appropriate in different specialities and settings. Thus a context description of the SCP is important to determine the conditions for its successful implementation and the possible limits of its transferability. At the same time an estimate of recourses used for implementation of the SCP, and a possible estimate of cost effectiveness will be asked for when collecting information on the SCP. To ensure opportunities for networking and in depth study each SCP will be provided with contact information of the person who supplied the information on the SCP. Patient involvement is an important topic and will be accounted for when available and appropriate. A special form for collecting information on SCP will be established according to key factors.

Process expected to be accomplished is:

• 
  involving partners in specifying their needs for knowing about SCP (topics for exchange mechanisms). This will happen in the initial Kick-off meeting in a brainstorm session, introduced by the WP Leader and deepened via the on-line data collection on SCP
  
• 
  setting criteria for collection of information, the selection of the SCP and the description on the web platform. The criteria must be in accordance with the glossary and the framework. The information collected and later displayed on the web tool, must suit the needs for action in the clinical field, e.g. a description of a SCP on “safe communication”, should contain a process description on how to obtain safe communication
  
• 
  preparation of a web-questionnaire for collection of information on SCP from JA partners. An easy accessible survey form will be striven for.
  
• 
  collection of information on SCP through consultation with JA partners at M7 - M10. Data collection will take place joined with WP6 via the PaSQ webpage. WP2 will be responsible for the web questionnaire and WP4 and 6 for content specification.
  
• 
  analysis and validation of the information received; M 10-14
  
• 
  selection and description of SCP. Where possible the descriptions of the SCP will be supported by a literature review
  
• 
  approving the selected SCP within the JA organisation.
  

3. 
   Defining concepts for exchange mechanisms and developing implementation support tools
   

The exchange mechanism will provide opportunities for MS to learn from one another with regard to the identified SCP, and to share experiences in working with them on a daily basis. The purpose of the exchange mechanism is the practical application of basic principles in the workplace; participants will learn how to apply the specific SCP in their work. Generally the exchange mechanisms will also contribute to strengthening the established EUNetPaS network. MS will be encouraged to arrange both national activities, and take part in activities arranged in other MS aiming at both learning & teaching.

In principle all the identified SCP can be subjected to sharing between health care professionals (the target group of WP4). However, different SCP might prove to be suitable for different sorts of exchange mechanisms, e.g.

• 
  Cross national meetings/learning seminars: where a national body can act as host and invite health care professionals from their own country to a seminar around the SCPs. Experts from other MS can be invited to tell or teach about the SCP and their experiences in their practical application. The meeting can be set up in an interactive workshop like fashion to enhance the uptake of information, and capacity and network building within the country. This meeting can target a large number of health care professionals, and may also cover more than one SCP. For example, a MS may be in the early stages of PS work and will set up a national seminar around the topics. They can then get started in PS work, organise PS work at the clinical level, and training and education in PS as well as identification of risk or harm. A number of experts from other MS can be invited to give input
  
• 
  Study tours: single or groups of health care professionals can visit an organisation/institution/expert with experience in a specific SCP e.g. safe medication, surgical safety or suicide prevention to study how to apply the SCP successfully. This form of exchange mechanism targets health care professionals with an interest in studying a specific SCP in depth and connect with an expert.
  
• 
  Workshops: a MS can act as a host for a workshop on specific themes e.g. identification of risk or harm, reporting systems, assessment of adverse events and risk according to frequency & severity and analysis and learning. The work shop will be open to health care professionals from all MS. Experts who have described the SCP will be invited to teach in the work shop. This form of exchange mechanism targets a large number of health care professionals with the same interest to learn. At the same time it builds a strong learning network among participants from other MS
  
• 
  Twinning: two institutions across MS twin up, and set up an exchange mechanism where health care professionals can teach or learn from one another on a specific theme in SCP. This form of exchange mechanism enables support in the process of working with the SCP over time.
  

The above outline of the exchange mechanism is to be further developed and conceptualised. WP4 will suggest themes and forms of the exchange mechanisms on the basis of input from MS in regard to their wishes and needs (data collection described above).

Process and support tools expected to be accomplished M10-M15 are:

• 
  review of SCP and suggestion of type of exchange mechanisms e.g. some SCPs such as “getting started in PS” could be a suitable topic for inclusion in an online learning course including useful documents, links to related websites, printable course material and key learning points, whereas other SCP like “analysing adverse events” might be more suitably for uptake through a learning seminar
  
• 
  describe and establish the specific concepts for the exchange mechanism
  
• 
  develop material for the NCP on the exchange mechanism
  
• 
  describe roles and responsibilities around different types of the specific methods for the exchange mechanism
  

4. 
   Sharing SCP through an interactive web tool
   

Information on the selected SCP will be shared through an interactive web tool developed by WP2. The content will be specified by WP4

Process expected to be accomplished is:

• 
  developing an on-line form for collecting information on SCP in cooperation with task group B according to the above
  
• 
  develop a suggestion for an interactive exposure of the WP4 glossary and the conceptual framework, and initiate approval process among JA partners
  
• 
  exposure of information on SCP at M15
  

5. 
   Feasibility analysis and action plan for the remaining project period.
   

The feasibility analysis draws upon information collected from MS (under bullet B above) and the resources available for the remaining project period. A short status of work will be given, and the support tools for the exchange mechanisms (developed under bullet C above) presented.

The action plan is a cross-project milestone. For WP4 the action plan will contain a proposal for exchange actions by type (meetings, training sessions, on line course, twining etc.), and if possible a budget outline and a tentative agenda for the actions will be outlined. The action plan will be available at M16.

6. 
   Implementation: sharing of SCP through exchange mechanisms
   

The organisation of the actual exchange will be under the responsibility of WP1 and organised in coordination with the NCPs. Implementation will be carried out according to the supporting tools developed by WP4 (Please see C above)

To ensure the uptake of information, and evaluate the success of the exchange mechanisms a short questionnaire will be developed and distributed to participants in the exchange mechanisms. The questionnaire will be in English; if local translation is needed this will be the responsibility of the NCP. Information from this questionnaire will be used for impact evaluation.

Process and milestones expected to be accomplished are:

• 
  implementation of exchange mechanisms M15-30
  
• 
  develop a short questionnaire for evaluation of the individuals experiences made during the exchange (se impact evaluation later).
  

Schedule of work

Please find below table 1 - the draft work schedule.
Table 6: Draft WP4 work schedule

Activity	Time frame (Project month)*	Task leader, partner or body involved
Kick-off meeting	2	DK is responsible
Review and data collection
Review and defining a common glossary	1-6	DK is task leader
Framework	6	DK is task leader
Coordination meeting (Milestone)	7	DK in coop. with host
Data collection: identifying and describing SCP	7 - 10	G is task leader
Preparation for exchange mechanisms
Status and feasibility analysis WP4	10 - 14	DK
Establish concept of exchange mechanisms & implementation support tools	10 - 15	HOPE is task leader
On-line exposure of SCP and issues of exchange mechanisms	15	AT is task leader in coop. with WP2, & WP6
Status, feasibility analysis and action plan
Coordination meeting (Milestone)	15	DK in coop. with host
Action plan (Milestone)	16	EB
Implementation of exchange mechanisms
Organising exchange mechanisms	15 - 30	NCP, WP1, WP4 & WP6
Implementation: exchange mechanisms	15 - 30	Participating WP4 partners
Considerations on sustainability of WP4 work	15 - 30	WP4 in coop with WP7
Reporting
Report of good clinical practice solutions in PS incl. approval (Deliverable)	34	DK in coop. with WP4 partners

* Project timeframe is stated according to M1: April 1^st 2012 through M36: March 31^st 2015.
Sustainability of WP4 work and deliverable

During the project the sustainability of the WP4 work will be discussed. Pre project it seems important to discuss sustainability of the interactive web platform with information on SCP. Also it will be important to test the exchange mechanisms in regard to sustainability. The test of the exchange mechanisms could in this regard be viewed upon as a sort of pilot of the concept.

The work of the WP will be described in a report of good clinical practice solutions in PS. The report will include the methodology used in the WP, the glossary, the framework and a description of the SCP. TLs will contribute actively in writing to the report in their respective fields of task solving. The final report will be drafted by the WP Leader; all WP4 partners will be invited to comment on the content before the final version is presented to the wider JA organisation for approval. The WP Leader will outline and handle the process of constructing the report. The approval process will be according to the JA SOP.

Deliverable 1 is common for WP4 and 6 and will presumably be a two-fold report with a part A and B or like wise. The final form of the report will be decided in the course of the project.