Definition and evaluation of Good Practices in Public Health

Background Despite the increasing use of the good practices tool in health care organizations, there is no commonly accepted definition of good practice in public health in literature, especially for the difficulty of reconciling effectiveness and operational feasibility with the traditional hierarchy of scientific evidence; the lack of a formal definition and the difficulty in finding a suitable spot in the scientific literature often undermine the possibilities for classifying and spreading successful experiences that can be considered "good practices", hindering the harmonization of approaches towards different problems. Aim of the study \u2022 making a systematic review of the literature on good practice definitions and experiences in Public Health, identifying the most recurrent concepts and problems in scientific papers, thus developing a definition of good practice in Public Health; \u2022 developing a tool for classification and evaluation of good practices in Public Health; \u2022 developing a set of recommendations for planning, implementation and self-evaluation of Public Health good practices, to facilitate the design of good practice considering the factors that prevent or promote implementation and dissemination; \u2022 field-testing the tool picking up a set of available good practices, evaluating the tool versatility in good practices classification for different realities (local, regional and national) and its ability to be consulted with ease; Methods Good practice definition has been developed using a systematic review of the available literature and a separate search through institutional websites and portals for good practices collections and European projects/Joint Actions. Using data from systematic review, 14 frameworks with good practice evaluation criteria were identified. All criteria from different frameworks were grouped into previously identified thematic areas (dimension). Scoring system was developed weighting each dimension with the number of citations inside the original systematic review. Results A total of 9378 abstracts were screened, 339 records were assessed with full-text and a definitive number of 74 records were included in the final review; all good practice concepts where grouped into five main dimensions: Effectiveness, Sustainability, Replicability, Reach and Context. FIRST tool (acronym for Frame, Impact, Resources, Spread and Target) was developed from 14 selected frameworks included a total of 122 criteria, grouped into Plan phase, Do phase, Check phase and Act phase, according to the quality improvement circle. During FISRT tool field testing, 340 good practices were randomly selected from three web-based portals and assessed using FIRST tool: 129 national good practices, 62 regional, 61 local and 88 single hospital GPs. Conclusion The study produced a definition of good practice built on five domains based on the evidence available in literature, including frameworks from the most recent European Joint Action experiences. The FIRST tool was developed using frameworks available in literature, representing the first evaluation and self-evaluation tool for good practices. The FIRST tool was effective in providing a picture of different good practices settings, describing stronger dimensions and improvement opportunities, while setting stratification proved the tool flexible, although more suitable for widespread interventions than little, more local, experiences.Presupposti dello studio Nonostante le buone pratiche siano strumenti di sempre maggior utilizzo in determinati contesti, manca in letteratura una definizione di buona pratica per la Sanit\ue0 Pubblica, soprattutto per la difficolt\ue0 di conciliare l\u2019efficacia pratica (effectiveness) e la praticabilit\ue0 operativa nei diversi contesti con la tradizionale gerarchia delle evidenze scientifiche; la mancanza di una definizione condivisa e del conseguente inserimento a pieno titolo negli strumenti riconosciuti dalla comunit\ue0 scientifica e professionale, comporta la difficolt\ue0 nel classificare e diffondere esperienze di successo che possono essere considerate \u201cbuone pratiche\u201d potenzialmente esportabili in altri contesti, ostacolando perci\uf2 l\u2019armonizzazione degli approcci alle diverse problematiche e potenzialmente delle performance. Scopo dello studio Realizzare una revisione della letteratura sulle esperienze e definizioni di buona pratica in Sanit\ue0 Pubblica che identifichi i concetti maggiormente ricorrenti nei lavori scientifici, che consenta di sviluppare una definizione di buona pratica in Sanit\ue0 Pubblica; Sviluppare uno strumento per la classificazione e la valutazione delle buone pratiche in Sanit\ue0 Pubblica; Testare sul campo lo strumento raccogliendo una serie di buone pratiche, valutando la versatilit\ue0 dello strumento nella classificazione di buone pratiche realizzate a diversi livelli l\u2019affidabilit\ue0 per realt\ue0 differenti a livello (locale, regionale e nazionale), indispensabile per testare la reale efficacia pratica dello strumento nel rappresentare le diverse realt\ue0 ed esperienze e la sua capacit\ue0 di essere consultato; Metodi La definizione di buona pratica \ue8 stata sviluppata attraverso una revisione sistematica della letteratura e una ricerca separata attraverso portali istituzionali con collezioni di buone pratiche nonch\ue9 progetti europei / Joint Actions. Utilizzando i dati della revisione sistematica, sono stati identificati 14 framework con criteri di valutazione delle buone pratiche. Tutti i criteri di diversi quadri sono stati raggruppati in aree tematiche (dimensioni) precedentemente identificate. Il sistema di punteggio \ue8 stato sviluppato ponderando ogni dimensione con il numero di citazioni all'interno della revisione sistematica. Risultati Sono stati vagliati un totale di 9378 abstract, di questi 339 lavori sono stati valutati full-text e un numero definitivo di 74 manoscritti \ue8 stato incluso nella revisione finale; tutti le caratteristiche di buona pratica sono state raggruppate in cinque dimensioni principali: efficacia, sostenibilit\ue0, replicabilit\ue0, portata e contesto. Lo strumento FIRST (acronimo di Frame, Impact, Resources, Spread e Target) \ue8 stato sviluppato da 14 framework selezionati includendo un totale di 122 criteri, raggruppati in fasi plan, do, check, act.in base al ciclo di miglioramento della qualit\ue0. Durante il test sul campo dello strumento FISRT, 340 buone pratiche sono state selezionate casualmente da tre portali web e valutate utilizzando lo strumento FIRST: 129 buone pratiche nazionali, 62 GP regionali, 61 locali e 88 GP di singoli ospedali. Conclusioni Lo studio ha prodotto una definizione di buona pratica basata su cinque dimensioni costruite dalle evidenze disponibili in letteratura, comprese le pi\uf9 recenti esperienze di Joint Action europea. Lo strumento FIRST \ue8 stato sviluppato utilizzando i framework disponibili in letteratura, e rappresenta il primo strumento di valutazione e autovalutazione per le buone pratiche. Lo strumento FIRST si \ue8 dimostrato efficace nel fornire una fotografia delle buone pratiche disponibili nei diversi setting, descrivendo le dimensioni pi\uf9 solide e quelle con le mag

Parental trust and beliefs after the discovery of a six-year-long failure to vaccinate

Background: In Italy vaccine hesitancy worsened after a failure to vaccinate episode that took place in Friuli Venezia-Giulia Region until early 2017 which undermined herd immunity by leaving unprotected more than 5,444 children. Methods: Between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic where they were invited within the subsequent extraordinary vaccination campaign. The aim of the survey was to evaluate whether the multi-channel extraordinary vaccination campaign had reached the target population and to know parental beliefs and trusted sources of information after the failure to vaccinate event. Results: While 279 parents were non-hesitant (10.9%) and 1,491 hesitant acceptors (58.3%), just 38 (1.5%) refused to have their children revaccinated. Overall, the most consulted sources of information were print media (18.8%), physicians (16.0%), relatives and friends (12.1%). The majority of parents considered vaccination as a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case. Conclusions: After the Codroipo case, most parents chose to have their children re-vaccinated and just a little proportion refused the re-administration of vaccines. More studies are needed to confirm the importance of a coherent multi-channel communication strategy using both traditional and new media in order to counteract vaccine hesitancy

Why do we need to develop public health good practices in Europe

Issue/problem: In the last decade, considerable efforts have been devoted in Europe to policies and programmes standardization, hoping to reduce the constantly widening health gap between countries. Nevertheless, there are significant differences in the way European countries manage many public health (PH) topics, both at national and regional level. In many PH fields there are evidences that suggest what should be done, but in many cases practitioners do not have access to these advances or fail to implement them. This fragmented situation leads to inequalities and waste of resources. Description of the problem: Many successful experiences exist at the moment but a definition of the characteristics of a good public health practice in Europe is lacking.The development of such a definition could facilitate both a common approach to public health programs and the possibility to collect them in an inventory accessible to all interested stakeholders. Results: The development of this definition should acknowledge the existing fragmented European reality and the need to review criteria reported in literature (i.e. effectiveness, sustainability, transferability, novelty, coherence with practitioners needs); to collect and analyze existing experiences; to involve stakeholders (i.e. professionals, decision makers, citizens); finally to reach a consensus. As a result a collection of experiences easily available could facilitate dissemination of practices and development of networks based on practices. Lessons: In all activities to develop definitions and standards promotes common language, culture and tools, reduces variability and facilitates the exchange of experiences. A definition of good PH practices in Europe could promote the adoption of effective PH programs, reduce inequalities, and save resources

Promotion of flu vaccination among healthcare workers in an Italian academic hospital: an experience with tailored web tools

Background: Influenza causes significant mortality particularly among the elderly and high-risk groups. Healthcare workers (HCWs) are at risk of occupational exposure due to contact with patients. Aims of this study was to promote flu shot among HCWs through a multimedia campaign in a large North-Eastern Italian Hospital. Methods: The 2013/2014 flu vaccination multimedia campaign addressed to HCWs was developed by maintaining pre-existing tools (letters in pay slip and poster displayed in wards) and creating 4 on-line spots (30") delivered trough the hospital intranet. Campaign effectiveness was assessed in terms of changes in knowledge, attitude and practice comparing data of pre (10 items) and post test (20 items) survey on a randomized sample of HCWs. Results: Response rates were 92.6% (464/501) in pre-test and 83.2% (417/501) in post-test. 93.8% (391/417) of HCWs reported to awareness of the campaign to promote vaccination. Spots were seen by 59.6% (233/391) of HCWs. Some reasons for vaccine denial, \u201cnot believing in vaccine efficacy\u201d (34.7% to 14.9%), \u201cnot considering flu as a serious problem\u201d (from 24% to 12.6%), \u201cthinking not to get sick\u201d (28.7% to 18.2%) or \u201cbeing against the vaccine\u201d (32.7% to 21%), showed a statistically significant reduction after the exposure to the campaign. The \u201cintention to get vaccinated in the next year\u201d instead, raised effectively (13.1% to 36.6%). Vaccinated HCWs rate in 2013-2014 season was 7.6% (221/2910), and 5.6% (164/2910) in 2012-2013 (p<0.005). Conclusions: The multimedia campaign succeeded with regard to KAP outcomes, but the vaccination rate is still far from the goal of 90%. Due to their impact, especially on younger age groups, web tools deserve to be better studied as effective approach to convey health information among HCW

PROMOZIONE DELLA CULTURA DELLA SICUREZZA TRA GLI OPERATORI SANITARI: IL PIANO DI MIGLIORAMENTO DELL\u2019OSPEDALE DI UDINE PER LA CORRETTA IDENTIFICAZIONE DEL PAZIENTE

Introduzione: L\u2019errata identificazione del paziente \ue8 una delle principali cause di eventi avversi in Sanit\ue0. In accordo con gli obiettivi internazionali per la sicurezza delle cure e gli standard di qualit\ue0 Joint Commision International, l\u2019Azienda Ospedaliero- Universitaria di Udine ha condotto nel biennio 2013-14 un piano di miglioramento finalizzato ad incrementare l\u2019applicazione della procedura di identificazione del paziente tra gli operatori. Metodi: Il piano ha coinvolto 24 strutture e ha previsto diverse fasi: formazione del personale con lezioni frontali; individuazione di link-professionals in ogni struttura con il compito di favorire la compliance alla procedura; misurazione pre e post intervento dell\u2019efficacia del programma mediante interviste strutturate a pazienti ed operatori, completate da osservazioni dirette dell\u2019applicazione della procedura da parte del personale. Risultati: Il percorso formativo si \ue8 svolto da aprile 2013 a ottobre 2014 e ha coinvolto 639 operatori di cui 440 (68.8%) infermieri. Il confronto dei dati ottenuti dalle osservazioni dirette del personale pre e post training ha mostrato un incremento significativo (p<0.001) [da 62.5% (30/48) a 96.6% (56/58)] della corretta applicazione della procedura. Le interviste al personale relativamente alle 5 occasioni in cui la procedura deve essere applicata hanno evidenziato al termine del percorso un aumento significativo (p<0.001) [da 68.6% (247/360) a 86.7% (312/360)] delle risposte corrette. I pazienti intervistati nella fase pre-training sulla frequenza con cui il personale applicava la procedura hanno risposto \u201csempre\u201d nel 60.5% (121/200) vs il 77.7% (157/202) degli intervistati nel post-training. Conclusioni: Il piano di miglioramento, valorizzato dal contributo dei link-professionals per il rischio clinico individuati nelle singole strutture, ha consentito di ottenere un sensibile miglioramento dell\u2019aderenza alla procedura di identificazione del paziente da parte del personale dell\u2019AOU

Professional attitudes toward incident reporting: Can we measure and compare improvements in patient safety culture?

Objective: To establish categories of professionals' attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators. Design: The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed. Setting: A 1000-bed Italian academic hospital. Participants: Staff of the hospital (over 3200 professionals). Interventions: None. Main outcome measures: NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions. Results: The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42-0.46) among doctors and 0.40 (95% CI: 0.39-0.41) among nurses. Between 2010 and 2015, only the doctors' reporting rate increased significantly (P = 0.04), from 0.29 (95% CI: 0.25-0.34) to 0.67 (95% CI: 0.60-0.73). Patient complaints decreased from 384 to 224 (P < 0.001) and work accidents decreased from 296 to 235 (P = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31-1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11-2.87). Conclusions: Because the doctors' reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues

Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA)

Purpose \u2013 The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach \u2013 A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings \u2013 The self-assessment tool \u2013 Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications \u2013 This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value \u2013 The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries