1. ‘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 13th International Conference on Health Promoting Hospitals (HPH) May 18-20, 2005 Dublin - Ireland

2. Short introduction to the context: LOCAL HEALTH UNIT LOCAL HOSPITAL UNIT 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. The HPH Safety Project involves: 2 Local University Hospital Units (Florence and Pisa) and 2 Local Health Units (Arezzo and Siena)

3. The “Safety” project: - Key concepts - The approach - The interpretation model - The work developed - The phases of the pathway training

4. Safety: Is a relative concept, to define on the base of the levels of ‘passive safety’ andactivesafety’ ‘passive safety’ and ‘active safety’ passive safety: the level of safety guaranteed by the adoption of the rules Key concepts : active safety : the level of passive safety increased through Health Promotion activities Acted by the awareness and co- operation of patients (and their relatives), health professionals and community Acted by the observance of the rules

5. Compensatory behaviour STARTEND Rules Passive safety observance of the rules END + The approach + Empowerment END Active safety Awareness, Health literacy, Participation …. Expected value Middle Situation Compensatory behaviour Global safety (?)

6. HPH ENVIRONMENTAL CULTURAL PHYSICAL LOGISTIC PROCESSES RE-ENGINEERING INNOVATION between: PATIENTS RELATIVES OPERATORS PARTNERS COMMUNITY RELATIONSHIPS Re-orientation of the Setting The interpretation model Integrated Planning Systemic vision: STANDARDS Professional vision: EMPOWERMENT Organizational vision: RE-DESIGN HEALTH GAIN

7. 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 active safety 3. Re-elaboration of this experiences and their synthesis in a shared project based on the active safety concept

8. 1. Study of initiatives made by Tuscany Hospitals SAFETY ON THE ‘PROCESS’ LEVEL SAFETY ON THE ‘RELATIONSHIP’ LEVEL SAFETY ON THE ‘SETTING’ LEVEL PROJECT Active safety Analysis Grid (selective) Active safety (Safety in the diagnosis and therapeutic process. Risk management) (Relationship and Hospital Safety) (Hospital Setting and safety) RE-ORIENTATION The phases of the training pathway

9. 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: 1 st requirementEMPOWERMENT 1 st requirement: EMPOWERMENT Others requirements: Others requirements:  FATTIBILITY  TRASFERIBILITY  POTENZIALE ATTRATTIVO  COERENCE WITH THE REGIONAL POLITICAL ADRESS

10. Experience 1. Experience 2. Experience 3. Experience 4. Experience 5. Experience 6. passive safety Middle Situation Active safety 100% 66% 100% 66% 33% passive safety Middle Situation Level of development of the local projects/experiences active safety EMPOWERMENT!

11. active 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 pressure sores Prevention of falls Prevention of falls Treatment with central intravenous catheter (CVC) Treatment with central intravenous catheter (CVC) Safety in the antiballistic therapy Safety in the antiballistic therapy Prevention of the latex allergies Prevention of the latex allergies

12. 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) constitution of a thematic Working Group (inter-corporate, inter- disciplinary character) elaboration of the timetable 2005 with the following goals: elaboration of the timetable 2005 with the following goals: - definition of a set of standards, both on the passive and the active safety level - definition of a set of standards, both on the passive and the active safety level - assessment of their feasibility - assessment of their feasibility - individuation of specific good practices. - individuation of specific good practices.