Innovation – AQuAS Blog

Improving the quality of healthcare in intensive care units. The PADRIS programme in the Tarragona Datathon 2018 (part two)

14 Feb

Today we continue the interview with Maria Bodí (@mariabodi23), doctor at the Intensive Medicine Service, and Josep Gómez (@JosepGomezAlvarez), doctor in Biotechnology at the Hospital Universitari de Tarragona Joan XXII, experts in clinical management and aspects of quality and safety in healthcare.

In your opinion, what are the conclusions of the so-called Real World Data studies which were carried out using real data in terms of benefits and risks related to patient safety?

Benefits? Everything. Information derived from a real healthcare environment is necessary to take decisions. Randomised clinical trials which have defined the effectiveness and safety of therapeutic interventions have served till now as a Gold Standard of the best scientific evidence. But they are very costly, and what is more, they are aimed at very selective groups of patients. Studies and analyses derived from the real world, known as Real World Data, mean it is possible to know the effectiveness and safety of interventions in groups of patients which are usually excluded from trials (pregnant women, older people, patients with many comorbidities who are the majority, etc…).

There is a series of limitations and obstacles that prevent Real World Data from substituting clinical trials. On the one hand, legal and ethical aspects and those concerning the guarantee of the quality of data. On the other, it is not possible to accept the bias that there is when not randomising Real World Data. Before taking decisions, we need to ensure that there are no confusing factors.

Real World Data complements the information obtained from clinical trials in routine clinical practice.

Some weeks ago we received the visit of Lucian Leape in Barcelona, author of the extremely famous book “To Err is Human”. We were fortunate to be able to listen to him in a talk at AQuAS – were you able to listen to him?

No, unfortunately we were not able to attend. It is a pity because we were told that it was a good review of what we have learnt in the past two decades in the field of clinical safety and that some good recommendations were made for the future.

In your opinion, what contributions did the To Err is Human report, published 20 years ago, make?

It revolutionised the field of safety. It was a paradigm shift which is still in place today.

The To Err is Human report denounced the thousands of deaths in the United States resulting from adverse events which could have been avoided! People who were dying in hospitals for reasons unrelated to the disease for which they had been admitted. The most important thing is that those events, those deaths, could have been avoided. Better training, better work organisation, knowing and analysing risks and teamwork, among other factors, have been shown to be key elements that contribute to reducing the amount of events and their severity.

What impact has the PADRIS programme had on your day to day?

In 2016, MIMIC-II was published, a huge set of de-identified data of ICU patients of the Harvard Medical School. It was created and has been maintained by researchers at the Massachusetts Institute of Technology. They published this dataset with the aim of democratising research. The idea is that after attending a training course on the treatment of data for research, you are certified as a practising researcher and you sign a document of usage: ultimately, to enable a researcher to have access to a large data base to carry out research. In addition, it encourages researchers to share the code (data processing methodology) that they have applied to data to obtain the results they publish. Altogether, it makes studies more transparent and repeatable which in turn increases the excellence of scientific production.

As a result of our experience in extracting data from the clinical information system to develop our management tool of the unit, we took on the challenge of generating our own data base to carry out research. Once created, we contacted the PADRIS programme so they could advise us regarding data anonymisation protocols and methodologies to get access to the programme in order to carry out research. They showed great interest in our project at all times and they helped us see it to fruition and thus the role of the PADRIS programme was decisive in making the Datathon Tarragona 2018 possible. We are in fact still in contact with them to define future strategies about how to make this data available for research projects without infringing any data protection law and how to broaden the database with data from other ICUs in the Catalan territory.

If you could make a recommendation to other researchers who wish to do research, what would it be?

We recommend they collaborate with experts in other fields, especially those related to data and statistical technology. We are now reaching a level of sophistication and volume of data that obliges us to work in multidisciplinary teams in order to make the most of data and to understand it the best we can. The datathons are a great example of this; the role of the clinician is decisive in defining aims and in validating the results that appear when cutting edge algorithms are applied by data scientists. At the same time, the role of data scientists is also decisive when suggesting and applying complex methodologies which are far removed from traditional statistics applied within a clinical context.

What professional challenge would you like to succeed with in 2019?

The ultimate professional challenge for 2019 is the same as each year: improving the care given to patients which are admitted to an ICU. To achieve this, we have some very specific challenges in our unit. On the one hand, to continue developing our tool to exploit data which enables us to analyse processes and the results obtained in our day to day and in this way become aware of where we need to place our attention to make improvements. On the other hand, taking advantage of the secondary use of data to carry out research and to generate algorithms for automatic learning which are able to help a doctor take the most accurate and appropriate decisions based on the profile of each disease.

(You can read the first part of this interview here)

Improving the quality of healthcare in Intensive Care Units. The PADRIS programme in the Tarragona Datathon 2018 (part one)

7 Feb

Last November, the AQuAS played an important role by means of the PADRIS programme in the Critical Care Data analysis Summit and Tarragona Datathon 2018. Talking about it has been in the pipeline since then.

The PADRIS programme contributes to the improvement of people’s health by making anonymised health information available for re-use by researchers in Catalan research centres, in compliance with the current legal framework and established principles.

Is this seen in practice based on a professional’s experience?

Today we interview Maria Bodi (@mariabodi23), doctor of the Intensive Care Medicine service in the Hospital Universitari de Tarragona Joan XXII, expert in clinical management and aspects of quality and safety in healthcare. Like many health professionals, she combines healthcare practice with research.

What is your day to day like?

As head of the Intensive Care Medicine Service at the hospital, in my day to day my basic task focuses on managing the service and organising the care for critical patients by coordinating the work of the professionals involved. More than 150 people work in the service including medical professionals (specialists in intensive medicine, resident intern doctors), nurses, nurse aids, ancillary staff, physiotherapists and secretaries. In addition, it is a service which participates and collaborates in the teaching of medical, nursing and physiotherapy degrees or certifications.

I try to facilitate the participation of professionals in the strategy of the service. This requires articulating and coordinating all efforts made with a clear objective in mind, which is providing quality care to our patients. To a greater or lesser degree, it is necessary to encourage and coordinate the participation of professionals in care-giving, management, teaching and research. This will guarantee the commitment of a worker in the service’s strategy and its organisation.

If we focus on medical professionals, each member of the team is in charge of a specific area of our speciality and we therefore provide ongoing training for the entire team, assess results and commit ourselves to carrying out actions which derive from the analysis of our results.

What do you think about the format that was used for the Datathon?

The Datathon was the result of a series of developments over recent years within the field of secondary use of data in patients’ clinical records for management and for research at a top level. The experience was very good. Pure science, with doctors, technicians and technology all at the service of real-life data analysis in order to find the best scientific evidence.

In the last three years, our group has delved deeper into the study of data and also into the assessment of the quality and safety of data for secondary use. Our progress has allowed us to collaborate with other leading teams such as the team of Dr Leo Celi of the Massachusetts Institute of Technology with whom we organised this event.

In your opinion, how can the quality of care be improved in intensive care units?

We have to aim for excellence. We need to tackle all the dimensions regarding quality of care. We need to improve effectiveness, safety and efficiency. But when talking about good and efficient results, we are not referring to the number of actions done at a particular cost. We are talking about bringing value to the patient, to the work team, the organisation, the health system and society. How is this achieved?

Our team has worked on developing a methodology which enables us to have automatic indicators of quality. This has been possible because all of a patient’s bedside devices (mechanical ventilation, monitoring, dialysis machines, etc.… ) are connected to the system of clinical information and this information, from the hospital’s clinical records, from laboratories and imaging tests, is integrated. This information is incorporated by professionals in an ordered manner.

By means of these indicators designed with innovative technology, it is possible to assess the processes of care and their results. If the professional participates in the design of a process of care, in its planning, and knows how things are being done and what results there are, they get involved and commit themselves to the aims of the service and the organisation.

Likewise, one needs to move from a reactive to predictive medicine, preventive and personalised. We have data with which to start working along these lines. Nevertheless, the scale and complexity of this data makes it difficult for methods of artificial intelligence to easily translate it into relevant clinical models. The application of cutting-edge predictive methods and data manipulation require collaborative skills between professionals who are medical and technology experts, as well as new models in the treatment and analysis of data.

We have read that it is possible to assess risk in an intensive care unit in real time. It seems difficult to imagine this. What can you tell us about it?

It can indeed. We work on the assumption that we have access to the data stored from all patients that have been admitted to an ICU, or in more than one ICU. If the combination of a group of variables (demographic, clinical, laboratory results) leads to a complication or an adverse event, a trained computer model using this data can predict the risk of the same complication or event occurring if it detects the combination of this group of variables. This is the basis of predictive medicine.

Understood, but in practical terms, what is purpose of assessing the possibility of a risk?

It can range anywhere from analysing a risk or predicting the appearance of a complication in the course of a disease, a problem of safety, an adverse event, the need for or an increase in dosage of a specific drug, to a specific therapy. It can predict the probability of an improvement or worsening and even the risk of death for a patient as a result of their disease.

Medicine already has calculators to assess a risk of death due to a disease based on data bases created by professionals using manual registers. But these days, with the automation of data registration- an example of this being the Clinical Information Systems in our ICUs – today’s methodology based on big data and artificial intelligence allows us to have much more detail when assessing risks.

When there is talk of moving towards a health model based on value, what does this mean exactly?

It is about organising work around the specific conditions of a patient which optimises their cure. It is a question of paying organisations and hospitals for the value they bring. Their results and their costs are the key components of the value which a health system and its professionals offer patients. But if we are talking about results, we are not only interested in whether a patient survives the ICU or not. Results are measured in terms of quality, their capacity of going back to their normal lives, their jobs, etc…

Therefore, to push efforts for improvement, we need to base ourselves on multidisciplinary work and a health model based on value; this means changing an organisation’s business model and investing in systems of measurement, analysis of clinical results and costs.

What importance do you attribute to the fact that data is obtained automatically and not manually?

It means data can be analysed using one source only, errors are minimised and a professional’s time is not required for the task of inputting the data.

How is the data included automatically?

In the ICU, clinical information systems now enable all information to be integrated. Apart from the data which professionals input in an ordered manner during the process of care of a critical patient, laboratory results, imaging tests, clinical records and the data from all a patient’s bedside devices are integrated too (mechanical ventilation, monitoring, dialysis machines, etc…).

What does “secondary use of data” mean?

Primary use is that which is used on a day to day basis, at the patient’s bedside, to take decisions relating to diagnosis, treatment and the planning of the process of care. For example, a decision is made whether to increase the dosage of a drug based on laboratory results.

We talk about secondary use when we refer to using data for management or for research. Obviously, the end aim is still the improvement of care for a patient.

(To be continued …)

PIPPI project: community of practice in procurement based on value

13 Dec

Innovation has been present in the AQuAS blog with projects such as Antisuperbugs and Ritmocore but there are many more on the go right now. Today we put the focus on the purchase of innovation and on how this innovative methodology can have an impact on clinical practice.

We interview Ramon Maspons, engineer specialised in the management of innovation and technology, coordinator of innovation at AQuAS.

What tools does the health system at present have within its reach to add value to healthcare?

The public procurement of innovation is one of the facilitating instruments when adopting innovation and developing policies for technology and innovation. Due to the characteristics of the health sector this becomes a strategic element. There are other sectors where this does not happen because the public purchaser does not have market power.

In what way does innovation provide added value?

At a first level, we could say that if there is no application no value is generated. At a second level, I would say that the changes in the process are what add value. And at a third level, we could talk directly about the user.

A very brief article was published not long ago on this subject in the journal Annals de Medicina. Recently, in another context, the King’s Fund published a report on models of innovation.

Could you highlight an innovative project within the field of innovation?

Yes, the PIPPI project, coordinated by the Karolinska University Hospital in which AQuAS is involved, together with six other institutions in the hospital and university environment in Sweden, Holland, Italy, Austria, Spain, Finland and the United Kingdom. It is a platform made up of hospitals from the European Hospital Alliance, which is the network of the most relevant European hospitals, and then AQuAS. The focus of this work group is the new models of procurement based on value using digital technologies as an element to transform health services.

Have you considered changing the name of the project?

No, but in fact yes, because the name has curious meanings and connotations in different languages. This was one of the subjects that arose in the Kickoff meeting of the project.

Jokes aside, what is the involvement of AQuAS in the PIPPI project?

The expertise of AQuAS in assessment, innovation and the procurement of innovation is key. This project proposes an environment where the different stakeholders involved in change can come to an agreement and work together, both when revealing the needs of a health system, of hospitals, as well as when involving companies, technological centres, universities, patients and caregivers.

It is a very ambitious aim. What would you say is special about this project?

Its strategic focus of putting the different stakeholders involved in improving healthcare in the same project but having the support of the leadership of hospitals and an assessment agency. Identifying needs and solutions using this vast network of diverse expertise is one of the strengths of this project.

How will the PIPPI project work?

The project needs to develop a community of practice where challenges can be posed and solutions considered within an international framework.

Could you be a little more specific about which environments digital technologies will have an impact on in the health services?

By all means. We can include very different subjects such as co-creation with clinicians, telemedicine, data analytics, artificial intelligence, and so on. Some aspects are nearer on the horizon and others more distant. There exists a powerful reflection on digital technologies: it is said that everything that is digitalised is dematerialised and demonetised (it may be a subject too complex to go into here) and there are also those who say that, in the end, what is digitalised is democratised, but now that really would be going into other subjects.

Earlier you mentioned involving patients – who and what are we talking about exactly?

The patient is a key element in procurement based on value because the patient generates value and this is something difficult for other sectors to understand. When we talk of digital transformation, the involvement of patients is often as necessary as it is a sensitive issue and a certain methodology is therefore required, or specific game rules. We are talking about complex systems which require complex ways of working where, among other things, very diverse sensitivities, organisational models, governances, health systems or types of providers are involved. In short, what we are talking about is getting patients to become a part of identifying needs and taking decisions; we are talking about expert patient concepts, the participation of citizens and about health literacy.

And how are you going to achieve all this?

As members of this consortium, we have the experience, knowledge, methodologies and leadership to forge ahead with a project of this nature. I recommend looking at the presentation of Romualdo Ramos and Tanja Stamm of the Medical University of Vienna to know more about this project.

What is the aim of the PIPPI project in a few words?

Impossible in just a few words, but can I do it in nine? Facilitating the joint design of the best healthcare possible.

Antisuperbugs: 3 million euros for technological innovation in the prevention of resistance of microorganisms to antibiotics

31 May

The healthcare market is one of the areas with the greatest purchasing impact in the public and private sector in Spain with a business turnover of 71 billion euros annually. It is a very complex market where the formulas used for purchasing both consumer goods and drugs, and services depend on the centres themselves. However, they also depend on the local regulations of suppliers, autonomous regions as well as state and community legislation.

This complexity does not only make it impossible for companies to make their products or services available to procurers but it is also often the interested parties in the purchasing that see the inclusion of these produces in their centre and their accessibility to their staff as a truly impossible mission.

And this is a whole lot more difficult when it comes to incorporating new technologies that meet the real needs of professionals.

In a panorama where investment in research and development is at its lowest point in recent decades, having a pre-commercial public procurement project subsidised by the European Union with 3 million euros is a big opportunity for companies that can offer their R+D services to create innovation which responds to the real needs of professionals.

An innovative public procurement project is an approach to innovation based on demand, where a group of procurers combine their resources to share risk in a joint R+D effort in the industry to provide solutions to needs which are not being met by the market. In the case of our project, it would be an ICT solution aimed at the early detection of microorganisms resistant to antibiotics (superbugs) in a healthcare environment, the Antisuperbugs project, coordinated by Jean Patrick Mathieu of the Agency for Health Quality and Assessment of Catalonia (AQuAS).

Antisuperbugs team (from left to right): Kristina Fogel, Sara Bedin, Maren Geissler, Dag Ilver, Benian Ghebremedhin, Jean Patrick Mathieu, Enric Limon, Gonçalo de Carvalho, Gemma Cabré, Esther Arévalo

The consortium coordinated by the AQuAS, an expert institution in the definition and execution of public procurement projects in innovation in Spain, consists of 6 contracting authorities (the Catalan Institute of Oncology – IDIBELL (ES), Hospital Mútua of Terrassa (ES), Sheffield Teaching Hospitals NHS Foundation Trust (UK), Helios Kliniken (DE), Universitaetsklinikum Aachen (DE) and Autonomous Province of Trento (IT)), and two expert institutions in their area of research at RISE ACREO (SE) and Sara Bedin (IT).

Enric Limon of the VINCat Programme (Surveillance of Infections) of the CatSalut, principal researcher of the project, sees having a detector of microorganisms resistant to antibiotics as a business opportunity for a company. In the United States, Asian and European Union markets, solutions are being sought that will make it possible to have a rapid detection system that activates early detection mechanisms. The resistance of certain microorganisms to antibiotics is creating a situation of alarm across the world to which the World Health Organisation (WHO) itself has drawn attention, estimating a figure of 50 million deaths in the years to come if adequate measures are not taken. The successful tendering companies will not only have access to funding but also receive the support of hundreds of professionals from six European institutions at the highest level in research and a potential market in a first phase of hundreds of hospitals and healthcare centres interested in purchasing a solution that they themselves have helped create.

Gonçalo de Carvalho, expert biologist in resistances at the Catalan Institute of Oncology, explains the need for this project to consider the possibility of creating new modules that when applied to the technologies themselves enable new detections to be made which makes purchasing them even more attractive to health institutions by adapting them to their own needs.

The tender which will be opened to companies in the next few months forms part of the Pre-Commercial Public Procurement programmes funded within the European Commission’s H2020 framework of reference. All the information regarding the Antisuperbugs project and the tendering options are available on the website of the project.

Interested companies can access the questionnaire of the open call of the market.

There is also the option for companies to offer their availability by putting in a tender as a consortium.

Post written by Jean Patrick Mathieu, Enric Limon and Gonçalo de Carvalho.

RITMOCORE: person centred public procurement

24 May

The need to place the patient at the centre of the model of care is widely accepted and is thus reflected in the Health Plan. Meeting this need is a substantial improvement in services and involves changes in the way these services are provided and that is precisely what innovation is all about.

What is needed, therefore, is to ask ourselves what instruments we have to incorporate innovation in public services and facilitate this change of model.

The RITMOCORE project, coordinated by the AQuAS, is in fact a public procurement of innovation initiative which aims to incorporate innovation in the provision of services to patients which carry or need a pacemaker. The end aim is to achieve care of higher quality, more personalised and ultimately, of more value for those patients who have been fitted with a pacemaker.

Public procurement has revealed itself to be a lever for change regarding the model of provision and organisation of health services and of the relationship with providers. This is why the AQuAS has driven several initiatives at a Catalan and European level in this area, such as numerous European projects or the recent call by CatSalut for PPI projects.

Catalan hospitals (Hospital Universitari de Bellvitge, Mútua Terrassa and the Hospital Sant Pau) and English hospitals (Liverpool Heart and Chest Hospital and Countess of Chester Hospital) have undertaken a joint bid under the clinical and administrative leadership of Hospital Sant Pau, and coordinated by AQuAS which will be published at the end of 2018. This bid will make it possible to contract a service that will make the tracking of all patients with pacemakers effective and stimulate their activation, and it will enable the selection of the most appropriate devices for each patient, promote the coordination between levels of healthcare and permit the management of change of the ICTs that are needed: an integral service in line with what the health plan requires.

This inspiring project provides a practical approach to everything regarding the key issues in re-orienting the model of care. It forces us to deal with the constraints of the regulatory framework of public procurement and make continual assessments of risk, but above all, RITMOCORE forces us to manage the complexity of multidisciplinary environments (medicine, nursing, contracting, finances, etc…) that provide a very enriching opportunity and a challenge at the same time.

Complexity is inevitably a source of innovation. Providing ourselves with the instruments to exploit all the potential in favour of the care of people is our responsibility. Society, the healthcare environment and collaboration with the private sector are highly complex realities which offer the opportunity to generate, adopt and spread innovation.

Post written by Marcel Olivé Elias.

Nurses in Barcelona adopt the culture of dialogue to define their professional future

5 Apr

Asking ourselves questions, reformulating questions, rethinking the way we want to be, what we need and how we want society to know and see us. This is, without doubt, a difficult exercise to carry out as individuals but it is even more difficult to do this as a profession.

Agreeing with each other is by no means easy. Training, method and a desire to do so is needed. Having these premises clear, we initiated the RESET project at the Official College of nurses of Barcelona (COIB).

Guided by the company Diàlegs, specialised in mediation in health, we initiated an unprecedented process of participation in the nursing profession during which we went out into the territory to find out what the concerns, needs, wishes, complaints and proposals of nurses in the province of Barcelona were.

The process lasted the whole of 2017, after which our corporation was given the commission to develop the strategic lines on which the college members of Barcelona want us to work along with thousands of ideas that they would like to process.

The difficulty of the project was considerable. Apart from the geographical distances that existed and the difficulties in getting nurses involved, there was the added difficulty of coming up with a dynamic that had to be participative so as to facilitate environments of conversation, discussion and consensus among the hundreds of female and male nurses who have different professional realities and therefore varying priorities.

The Diàlegs company took on the challenge of making it possible by means of a process lasting 12 months during which participative methodologies were used to define the profession as it is today and that of the desired future. The framework for the project was based on the principles, values and methodologies of mediation, which led to a broad and necessarily inclusive view of the differences and susceptibilities of the nursing community.

The RESET project was carried out in three different stages: in the first stage, open debates were set up in circles of group discussion. The circles enabled a comprehensive collection of very valuable data which formed the basis on which to develop the following stages that consisted of two days of consensus: one to agree on the diagnosis of the situation the profession finds itself in now and another to define the future, with the aims and lines of action to be developed.

As a result of these three stages of the RESET project, 52 group discussion circles with 925 participants were set up, that is, with people who participated one or more times. 3,762 ideas were collected as well as some proposals for the future, with nine thematic areas and 65 lines of action decided on by agreement. The level of satisfaction was very high and the participants showed a high level of interest in continuing in the project, repeating participations in the three stages.

It must be said that the key to the success of the process was the large number of people that committed themselves to the project right from the start. We are referring to what we called the Driving Group made up of 208 people (with representatives from all over the territory, all positions and susceptibilities) who worked from the start both in the co-design of specific aspects as well as in the diffusion, organisation of group discussion circles and participation in the events for consensus.

Beyond the results of the RESET project, which are, in the end, a commitment to change with implications for the upcoming years, we still have much to learn and this can no doubt be extrapolated to the professional disciplines in health in which we are organised through colleges. We need to continue asking ourselves questions both in and out of the college organisations to positively drive change and development in all the aspects which bring us together as professionals. Continuity in the culture of dialogue is one of the most important challenges that came out of this fascinating process. This was the message that the nurses who worked in the Reset Project gave us. Therefore, from the COIB, this is our commitment.

Post written by Núria Cuxart Ainaud, director of programmes at the COIB, and Glòria Novel Martí, founding director of Diàlegs.

Towards research in nursing with a (greater) impact

15 Mar

What is it that makes a particular research have an impact on society beyond the strictly academic and which is truly transformative? Can a whole series of actions be planned in the way that one follows a cooking recipe which leads directly to the desired social impact? Unfortunately, the answer is no. The impact is multifactorial and depends on so many different elements and actors that it is difficult to establish a formula to guarantee it.

However, having said that, the fact that there is research which has a particular social impact does not mean that it is a totally random phenomenon and that there is no way of predicting, facilitating or promoting it. Years ago, from the Research Assessment group at the Agency for Health Quality and Assessment of Catalonia (AQuAS), and with the help and complicity of the International School on Research Impact Assessment, ISRIA, we identified a series of facilitators with regards the impact of research.

A fundamental facilitator is people, and the values, culture and capacity of leadership they have. Two identical results of research can have different impacts if the capacity of leadership, drive and will to get beyond academic impact is different. But this is still not enough. The strategy, organisation, collaborations and openness that institutions have will be a great facilitator or barrier for the researchers that have carried out the research.

Finally, both people and institutions will need two indispensable elements in order to aspire to having an impact: on the one hand, a close and effective communication with the different social actors that can play a role in transferring the results of research, and on the other, an approach focused on the participation of all these key players.

To paraphrase Confucius when he said “explain it to me and I will forget, show me and maybe I will remember, involve me and I will understand”, it is all about involving all the necessary actors to bring about a real change and make research transformative.

It is in this context that SARIS (Catalan acronym) came into being, the Assessment System of Research and Innovation in Health. It is a strategic tool which emerged from the PERIS (Strategic Plan for Research and Innovation in Health 2016-2020) with the aim of assessing the research carried out in health in Catalonia from the perspective of always wanting to facilitate and influence so that it has an impact beyond academia. To do this, the motivation and involvement of actors has been defined as a key factor for its development.

Last November, we started a series of participative sessions with nurses who were selected from the PERIS 2017 call in which a line of intensification of nursing professionals was financed.

It is important to emphasise that launching this line with nursing research makes full sense for three reasons: on the one hand, one of the thematic priorities of the PERIS is clearly that of “the development of clinical and translational research which facilitates the growth of scientific and technological knowledge, putting special emphasis on primary care agents and research in nursing”. In addition, the PERIS 2017 nursing fund has been the first to come to an end and it was appropriate to address ourselves to them first and foremost.

Last but not least, the conditions in which nursing research is carried out, with patients and their recovery as its central goal, makes it especially appropriate to ensure that this research has a direct impact on health. Hence, it is important that the research done in nursing be capable of demonstrating the impact that this group of professionals has because it can give it a comparative advantage with regards other biomedical disciplines. Indeed, nursing research is intrinsically translational.

Therefore, the first session centred on identifying the influential actors and in empowering the nurse to carry out an effective communication which amplifies the productive interactions needed to transform the results obtained into benefits for a better and improved health for patients.

We would like to express our deepest gratitude to the nurses for their participation (readiness and motivation) who attended of their own free will and in their time off work ensuring thus that the session was a success. This demonstrates that from the AQuAS we have leverage to give support to those researchers who are motivated to driving the impact of their research.

At present, we are preparing other sessions that will enable mutual learning between researchers and the assessment agents at the AQuAS.

Post written by Núria Radó Trilla (@nuriarado).

Jornada SARIS: Participación en recerca Barcelona, April 4th 2018.

The experience of assessing innovation

1 Mar

Clàudia Pardo, a consultant of open innovation at Induct accompanies and helps entities in the health sector to adapt to the new needs of the future. Clàudia Pardo, together with Dolors Benítez, led the first edition of Innovate and Assess (see the previous post), a training programme of the Observatory of Innovation in Healthcare Management in Catalonia (OIGS).

This is why today we offer you an interview in which Clàudia Pardo of Induct talks to Francesca Moya, a specialist doctor in rheumatology, at present the Director of Processes and Quality in the Area of Healthcare in Mútua de Terrassa. We would like to share her experience at the OIGS in the context of the Innovate and Assess workshop because we feel that it could be of use to many other professionals.

What would you highlight about the OIGS in terms of assessing innovation?

The observatory has been an important lever in introducing the concept of innovation in micromanagement and healthcare practices among professionals and management teams. Personally, the OIGS has given me the necessary methodology and support to identify potential innovative practices and to introduce assessment in the project development process of projects that professionals themselves propose. It has also allowed me to get to know the experiences of other centres, to learn from this and to encourage relationships between other professionals.

In your opinion, why is assessing innovation in healthcare practices important?

The only way to quantify a clinical or organisational improvement that has been put into practice is to assess it. We learnt this during this OIGS course. The scientific interest that professionals have in innovation, with the aim of including new practices or technologies to bring us closer to an improved healthcare, can sometimes mean that certain resources are assigned to practices which do not provide any value and this can have a high cost, not only economic but also of opportunity and lead to inequality in the system.

How did the need arise to start assessing good practices in healthcare in your centre?

Innovation in healthcare practices is necessary if they are to be improved, and assessing it is essential to quantify improvements. I would say that the need to assess arose out of the curiosity and need to know whether what we are doing, including the novelties that we implement and the resources of all types that we assign, are in any way relevant to our clients and to the organisation. But there is another important aspect which encouraged and motivated us, by no means a minor one; giving visibility to everything we do and sharing it all as well as acknowledging the efforts and contributions of the professionals who make it possible to improve the health system. The OIGS is a tool aimed at facilitating the entire process.

What advice would you give when incorporating assessment in innovation?

In my experience, I think the first thing to consider when wanting to assess what is being done is to think about this from the start of any project that is to be implemented. Let me explain myself: one of the greatest problems that I have had personally when wanting to assess a practice, experience or project has been the lack of necessary data, problems of design and the lack of knowledge regarding the adequate methodology needed to do it. Therefore, my advice would be to start any new project by planning what you want to achieve and what you need to measure in order to know whether you have been successful or not. Methodology is basic in the field of assessment and that is the expertise of the AQuAS.

What reasons would you give the centre to take on this approach?

I consider that knowing the results of what we do is basic for our organisations so that we are aware of the value it has, what it offers us, whether we should continue doing it, whether we can apply it to other areas of care, whether we should forget about it and change it for other practices or whether we can improve it.

Interview by Clàudia Pardo (@Claudiia_Pardo), Induct (@InductES).

Innovate and Assess: how to incorporate assessment in innovation

22 Feb

Incorporating the culture of assessment in innovative initiatives was the starting point and the challenge from which the Observatory of Innovation in Healthcare Management in Catalonia (OIGS) initiated the first edition of the Innovate and Assess training workshop, a programme to train “Agents of Change” with the focus set on assessment and innovation.

What were the contents of this initiative?

What is innovation, what is assessment and what is the OIGS’s process of assessment?
The management of change to provide tools to encourage assessment

A practical session in assessment
The conceptualisation of a proposal to implement the assessment of an innovative initiative

From the Agency for Health Quality and Assessment of Catalonia (AQuAS) and via the Community for Innovation of the OIGS, a process of assessment has been driven allowing the quality of methodology in innovative practices to be measured within the framework of the public healthcare system of Catalonia, offering professionals in health and organisations the opportunity to opt for the certification of their experiences as an added stamp of quality.

This workshop has enabled experts in innovation to get in touch with experts in assessment and share their knowledge with each other in order to improve the quality of assessment of innovation.

This training activity has been accredited with 2,0 credits by the Catalan Council of Ongoing Training for Healthcare Professions.

The main aim has been to create and facilitate the necessary tools to be able to carry out assessment and innovation in healthcare centres in an adequate manner.

On the one hand, Cari Almazán, Cristina Colls, Núria Radó, Dolores Ruiz-Muñoz and Maite Solans, experts at the AQuAS in different disciplines participated, working with professionals and provided their knowledge and recommendations from the point of view of assessment.

On the other hand, Dani Bernard, Ignasi Clos, Xavi Olba and Clàudia Pardo of Induct, offered their expertise in the field of innovation using dynamics and techniques such as user journey map and cubbing.

Cubbing

With the intention of boosting the number of certified innovative initiatives (as we mentioned, using criteria to measure the quality of methodology), as well as spreading the word about the Observatory as a support tool in the assessment of the Catalan healthcare system as a whole, the AQuAS provides assistance, or mentoring, to all those professionals that provide self-evaluations of their own experiences but who do not attain the required quality of methodology to obtain certification.

At present, the OIGS has become a point of reference within the Catalan healthcare system, and day after day it places value on the effort made by organisations that share and divulge their innovative experiences and who promote the assessment of innovation.

Post written by Dolors Benítez.

Medical information in the press and the doctor-patient relationship

15 Feb

For years, I have been under the impression of not having a clear idea of how information related to the complex world of medicine and health should be disseminated in the daily news media, both of the science that it is based on and of the difficulties and dilemmas in applying it in practice.

I have repeatedly refused offers, with only rare exceptions, to write texts on these subjects in newspapers or books of a non-professional nature: I had serious doubts of how to transmit this knowledge to the public at large. Looking back critically on these reservations I have had, I think they have been related to the paternalism inherent in the medical training received by the professionals of my generation: the fear that the public will make an incorrect interpretation and come to abhorrent conclusions of the facts disseminated, an audience with little knowledge on the theoretical foundations and subtleties of these facts, which are only accessible with proper professional training. Indeed, experience has shown me that these reservations were indeed justified.

However, at the same time, I have witnessed the growth of citizens’ autonomy, now widely acknowledged, and their right to take “informed decisions”. This position, which has come to define the 21^st Century as “the patients’ century”, acknowledges their right to know relevant professional data so as to be able to take accurate decisions autonomously; it has an undeniable foundation but if we are to avoid that this leads to the proliferation of distorted facts it will require a rigorous preparation and an absence of spurious interests on the part of those divulging information. Ideally, these informants should contribute to “health literacy” in a way that is balanced, objective and unemotional.

The tension between these two conceptions of health information goes in parallel with that which exists between two extreme views of the doctor-patient relationship: the classical paternalistic one (“the doctor knows better than anyone what is best for a patient and their decision must be accepted”) and that of the “informed consumer” with autonomous decisions. The other extreme of this corresponds to an “imminent revolution” in which it would be the very well-informed patient, (basically as a result of the spread of refined computer technology) that would take the most important decisions concerning themselves.

Personally, like many others, I prefer a more balanced approach: that corresponding to the “interpretative” and “deliberative” models of the doctor-patient relationship, in which the experience and knowledge of the former interact with the latter respecting their autonomy.

I think that this dilemma runs parallel to the medical information found in daily news media: on the one hand, there is the social demand to inform citizens of current advances so they know their options or opportunities as “informed consumers”; on the other, there is the temptation to fuel the emotions (triumphalism or fear) of the reader who is untrained by offering them information which is largely uncritical, lacks rigour or is insufficient, with the risk of a biased, distorted or exaggerated interpretation. The more or less unreal notions that some informants may have on medical and health problems (common, alas, among many professionals) can be transmitted like this directly to the citizen and to their emotions and desires.

In the case of news related to medical advances and innovations, I would like citizens to know what expectations these novelties raise, maybe now within their reach, and the magnitude or relevance of the problem that can be lessened or resolved, and that this be done by using a rigorous and prudent terminology so that citizens can also create their own opinion on the solidity or temporariness of an innovation, and of the related uncertainties and limitations: not only of the benefits that they can provide them with but also of the undesired, uncomfortable or harmful side effects they might produce, and whether they are in anyway frequent or probable. In other words, I would not like the main aim of this information to be that of creating hope or fear in the reader, or give them the idea in a triumphal tone that in the wonderful world of science, the war against disease has claimed a new victory, especially at the hands of local researchers.

I have recently taken part in an analysis of the news published in the daily press in Catalonia on medical innovations.

Even though some well-documented news described in sufficient detail was found that could provide balanced information to the reader in this analysis, in many other cases the information was one-sided or not very thorough and was devoid of facts related to questionable aspects of the innovation and their risks. It resulted in a biased message which often tended to induce optimism in the reader rather than educate them in the knowledge of the pros and cons of the medical innovations.

At a time when there is a call for a user’s well-informed autonomy, I would be delighted if healthcare culture and the attitude of the news media did not amount to a paternalistic doctor-patient relationship. In this regard, there is no doubt that much still needs to be done.

Post written by Gaietà Permanyer Miralda. Emeritus physician. Unit of Epidemiology, Cardiology Service. Hospital Vall d’Hebron, Barcelona.