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									      13th International Conference on Health Promoting Hospitals (HPH)
                                   May 18-20, 2005
                                   Dublin - Ireland




‘Active’ safety in the Tuscany Health Promoting Hospitals Network :
                      From Training to Project




          F.Simonelli, L.Colonna, L.Tavanti, M.J. Caldés Pinilla, K.Majer
Short introduction to the context:
The HPH Network of Tuscany is co-ordinated by the A. Meyer University
Children’s Hospital, involving all the 16 Local Health and Hospital Units of the
Region.




      LOCAL HEALTH UNIT


      LOCAL HOSPITAL UNIT




                      The HPH Safety Project involves:
             2 Local University Hospital Units (Florence and Pisa)
                 and 2 Local Health Units (Arezzo and Siena)
The “Safety” project:


     - Key concepts
     - The approach
     - The interpretation model
     - The work developed
     - The phases of the pathway training
Key concepts :

  Safety:
   Is a relative concept, to define on the base of the levels of
   ‘passive safety’ and ‘active safety’

   passive safety:
   the level of safety guaranteed by       Acted by the observance of the
   the adoption of the rules               rules



   active safety :
                                           Acted by the awareness and co-
   the level of passive safety increased   operation of patients (and their
   through Health Promotion activities     relatives), health professionals
                                           and community
The approach
                       END    Active safety
                              Awareness, Health literacy,
                              Participation ….



                       END     Middle Situation
                               Compensatory behaviour


               START    END    Passive safety
                               observance of the rules


Rules
   +
Compensatory
behaviour
                                   Global safety (?)
   +
Empowerment
              The interpretation model

                                         Systemic vision:


                                                   • CULTURAL
                    ENVIRONMENTAL                  • PHYSICAL
                                                   • LOGISTIC

                                          STANDARDS



                                   Organizational vision:


                                                   • RE-ENGINEERING   Integrated
    HPH                PROCESSES
                                                   • INNOVATION        Planning
Re-orientation of
  the Setting                           RE-DESIGN




                           Professional vision:           between:
                                                    •   PATIENTS
                                                    •   RELATIVES
                     RELATIONSHIPS                  •   OPERATORS
                                                    •   PARTNERS
                           EMPOWERMENT
                                                    •   COMMUNITY
The work developed

     A specific training programme composed by five
     seminars for operators participating to this project




                 Tree phases of the training programme



   1. Study of initiatives made by Tuscan hospitals on the safety issue
   2. Analyses of this experiences, ‘choosing’ those in the health
   promotion field
   3. Re-elaboration of this experiences and their synthesis in a shared
   project based on the active safety concept
The phases of the training pathway
1. Study of initiatives made by Tuscany Hospitals

                                    RE-ORIENTATION
              Active safety                                          PROJECT

                                                                 Active safety
            Analysis Grid
             (selective)

                            SAFETY ON THE         (Hospital Setting and safety)
                            ‘SETTING’ LEVEL

                   SAFETY ON THE
                   ‘RELATIONSHIP’       (Relationship and Hospital Safety)
                        LEVEL
      SAFETY ON THE         (Safety in the diagnosis and therapeutic process. Risk
     ‘PROCESS’ LEVEL        management)
2. Analyses of this experiences, ‘choosing’ those in the Health
Promotion field

For this analysis the participants have been using a specific grid

made themselves whit the help of the teaching and tutors


Criteria for the selection:


     • 1st requirement: EMPOWERMENT

     • Others requirements:
          FATTIBILITY
          TRASFERIBILITY
          POTENZIALE ATTRATTIVO
          COERENCE WITH THE REGIONAL POLITICAL ADRESS
Level of development of the local projects/experiences



      Experience 1.     100%


                                                         EMPOWERMENT!
      Experience 2.     100%        33%




      Experience 3.     100%                    100%     33%




      Experience 4.         100%
                                                               passive safety

                                                           Middle Situation
      Experience 5.         100%          66%
                                                           active safety

      Experience 6.   66%




                      passive                                  Active
                                           Middle
                       safety             Situation            safety
3. Re-elaboration of this experiences and their synthesis in a shared
integrated project based on the active safety concept



The results of this analysis and elaboration was the identification of

the following five arguments:

   • Prevention of pressure sores

   • Prevention of falls

   • Treatment with central intravenous catheter (CVC)

   • Safety in the antiballistic therapy

   • Prevention of the latex allergies
Progress made after the end of the training pathway (December, 2004)



For each sub-project:

   • constitution of a thematic Working Group (inter-corporate,
     inter- disciplinary character)

   • elaboration of the timetable 2005 with the following goals:

       - definition of a set of standards, both on the passive

        and the active safety level

      - assessment of their feasibility

      - individuation of specific good practices.

								
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