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Research Outputs

Work Package 10

Research Topic

Development of patient safety indicators in a context of accreditation for primary care

Lead: National and Kapodistrian University of Athens (UoA),

Contact:  Yannis Skaldikis

Description of work


As we have developed our work on patient safety we came to the realisation that there were some health jurisdictions in the EU where there was very little activity in patient safety. Physicians from Greece, Romania and Poland who attended the Linneaus workshop in Manchester in October 2010 impressed upon us the problems that isolated practitioners faced in trying to improve patient safety in the areas in which they worked. We also recognised that national health authorities were keen to accredit the work of clinicians and practices within their jurisdictions. There are both economic and quality issues driving the need to develop accreditation of health centres and clinicians, but the drivers do not tend to include concerns about patient safety. We felt that there was a real need to consider how we might develop a system for the accreditation of health centres for patient safety. The co-ordinator of the LINNEAUS Project in Greece is the Vice President of the National Committee for Quality for public healthcare organisations and Member of the Executive Board of the National Evaluation Centre for Quality and Technology in Healthcare, responsible for Quality and Accreditation.

Why the research topic is important

The evaluation of health care organisations in Greece has not been developed with the speed that is experienced in other European countries. Certification and accreditation lags considerably behind the internationally accepted standards. Although there are many cases of individual departments, especially laboratories, that have been certified, only a tiny fragment of all clinical departments of public and private hospitals in Greece have certified or accredited their services.

In this context, the need for accreditation has become increasingly important, especially in the light of the financial crisis in Greece which is placing huge costs pressures on the health system. Healthcare managers are trying rationalise costs whilst maintaining and improving quality. The need to accredit healthcare organisations is therefore becoming imperative and urgent. From our discussions with key stakeholders in Greece, it is also clear that primary healthcare services have not been sufficiently targeted in terms of safety and quality initiatives, with the greatest emphasis for improvement being targeted at secondary services. In discussions with senior civil servants in Greece we were specifically asked to work with the National Working Group on Quality in the Ministry of Health to develop an initiative for patient safety in primary care. We were informed that the Ministry for Health in Greece was considering steps towards developing an accreditation system in health centres in the north of Greece and was willing to support our specific proposal to address issues related to patient safety in a future accreditation system. This work package would therefore provide a useful preparatory action for this initiative.

What have we done (our approach)

As part of this accreditation initiative in Greece, a range of quality indicators are being developed for primary care and we believe that this presents a unique opportunity to assess the feasibility of developing consensus on, and then introducing, a range of safety indicators that can be used as part of the nationwide effort to accredit primary care health centres. The work that we plan to carry out is therefore complementary to the national policies in Greece. The Greek participation in the LINNEAUS Project will build on the development of quality indicators for clinical services that is already being undertaken in Health Centres throughout Greece. The LINNEAUS collaboration can therefore pave the way for the national strategy to accredit primary healthcare services in Greece.
The system that we will pilot will include utilising the adverse event reporting system which has been developed by WP2, and the safety culture instruments developed by WP5 as a first step towards accrediting safety. These are considered to be one of the prerequisites for any valid attempt to accredit the clinical services delivered in the selected Health Centers. If successful, this work will be sustained after the lifecycle of LINNEAUS Project by the selected Regional Health Authority. We hope that it will enable the accreditation system to be extended to other Health Centers within the same or other Regional Health Authorities with the ultimate aim of developing a fully fledged regional system for quality and safety accreditation with its own database in primary care.

The pilot health centres in Northern Greece who have already been recruited following a successful workshop held in Thessaloniki in December 2011. Over 20 physicians from the most complex urban health centers, rural health centers and satellite health centres participated in this workshop. An analysis will be undertaken of the current situation in the delivery of primary health and a focus on the microenvironment of the health centres to be considered as pilot sites. Workshops and use of established consensus building techniques with primary care physicians to obtain agreement on a minimum set of indicators on patient safety will also take place. Established indicators that have been developed as part of the Linneaus collaboration will be tested for use. We expect to use 2-3 indicators covering areas such as prescribing, adverse event reporting and safety culture. The rationale of the proposed work is based on the fact that monitoring, identifying, analysing and finally, rectifying potential deviations from best clinical practices should eventually lead primary healthcare services to be approved (or accredited) by the relevant scientific bodies and health authorities.

What is/are the key result(s) and why are the results important?

The lessons learnt from this process in Greece has the potential to impact the development of accreditation for patient safety in primary care in other similar health jurisdictions where primary care is poorly developed in relation to secondary care services – for example Romania, Bulgaria, Poland and Lithuania (countries where the LINNEAUS collaboration has existing links) and which have the range of primary care centres with which we will be working with in Greece.

The experience in developing such a system would be highly relevant to health systems in parts of Europe where physicians were working in relative isolation. The National University of Athens was already involved in advising the Ministry of Health in Greece and in our view had the knowledge and expertise to take this work forward with our help.

The proposed work in this WP contributes plans to pilot the application of selected patient safety indicators in primary care and to use them as a preparation towards accreditation of clinical services of the relevant healthcare organisations. This work package will link with WP2, WP4, WP5, WP6, WP7, WP8, WP11 and WP12.

National and Kapodistrian University of Athens have only recently joined the network so the following outputs are not yet available.

Tools and Guidance notes


Journal papers


Conference proceedings


LINNEAUS deliverable(s)


Other LINNEAUS reports