Comparing Quality efforts across Europe: now and in the future

1. Comparing Quality efforts across Europe: now and in the future Rosa Suñol, MD, Ph.D. Director, Avedis Donabedian Foundation Director AD Quality Chair. Fac. of Medicine. Autonomous University of Barcelona

2. Quality efforts in Europe. First developments • 1979 CBO in the Netherlands • 1981 First QA programs in Spain • 1982 First WHO meeting “Principles for Quality Assurance • 1983-5 First European Societies and ISQua Foundation

3. Common trends ofthe first efforts • Leaded by health professionals (doctors and nurses) • Based on audit • Hospital oriented (clinical and organizational). Spread initiatives in PHC in some countries • Majority of initiatives taken in public centers

4. Present situation • Laws • Public accountability (accreditation and certification) • Total Quality management • Cost of technology, clinical guidelines and evidence based medicine • Indicators • Patients’ opinion

5. Legal framework (80 -02) • Patients’ rights (access, general coverage, “good quality care”, ) • Medical/professional competence (re-certification etc) • Quality efforts (accreditation, measurement or improvement. Not quality level, few quality compromises) • Risk protection (radiation, etc)

6. Public accountabilityefforts (95 - 02) • Accreditation (optimal processes and functioning with pre-determined professional standards specifically health oriented) • ISO certification (based on documented quality system, process management and decreasing variation. Applicable to all sectors) • Public disclosure of information indicators

7. Accreditation Accreditation in Europe: survey 2001. CD Shaw

8. Accreditation growthin Europe Accreditation in Europe: survey 2001. CD Shaw

9. ISO certification in European healthcare sector (2000) www.iso.org

10. Agentes facilitadores Resultados Resultados en las personas Personas Política y estrategia Resultados en los clientes Liderazgo Procesos Resultados clave Alianzas y recursos Resultados en la sociedad Innovación y aprendizaje TQM. EFQM model(91 -02) • General framework • Based on a developmental approach (goal: excellence) • Useful to develop comprehensive • managerial model • Need of specific adaptation • (process and out-comes) • Possibility of combination with accreditation and ISO Liderazgo

11. Cost of technology, clinical guidelines. Evidence basedmedicine (92 -02) • Structured initiatives in almost all countries • Awareness on unexplained variability and research on clinical effectiveness • Different guidelines for the same condition • Present interests: • Strategies for implementing • recommendations) • Cost effectiveness recommendations • Client preferences

12. Indicators • Initiatives in most countries. Interest in out- comes or key processes • Public availability of data (UK,...) NHS Performance indicators Feb. 2002

13. Indicators NHS Performance indicators Feb. 2002

14. Patients’ opinion • Few countries with national data • Few comparative initiatives Wensing M, Vedsted P, Kersnik J et al. “Patient satisfaction with availability of general practice: an international comparison” International Journal for Quality in Health Care 2002 (14) 111-18

15. Present situation • Added governmental initiatives (top -down) • QI in contracts (hospitals and PHC • Extensive programs with important investments ( accreditation, indicators..) • Begining of information disclosure to the patients Less clinical involvement ??

16. Last 5 years topics • Clinical guide -lines • Accreditation/ISO/ EFQM • Indicators • Technology assessment

17. Agenda for thefuture: coordination ? 1. Globalization: European model and sustainability 2. Health Agenda. Clients´ priorities and participation 3. New systems of providing health care

18. 1. Globalization.European model andsustainability • Values: Diversity and role of ethics in management and rationing priorities • New concept of effectiveness (undercoverage, underuse, quality of life) will force to rethink efficiency measures • Citizens mobility: Accreditation and certification • Important issues: Safety, Public Health Q

19. 2. Health Agenda. Clients: priorities in QI programs • Patients’ Priorities / expectations (% patients with maximum score)

20. 2. Health Agenda. Clients • Information and health decisions. • Patient access to large amounts of • information (Internet…) • Public disclosure of clinical indicators • Shared consent (anxiety support, language adaptation) • Risk of loosing the philosophy of continuous improvement excellence • Risk of the professionals feeling overwhelmed and not reporting all information Q

21. 2. Health Agenda. Clients participation • Participation of citizens in deciding priorities • Lack of technical knowledge and little inclination to share difficult decision-making • Difficulty in feeling represented. Government role • Research and introduction of new ways allowing effective participation Q

22. 3. New Systems ofproviding of Health Care • Social changes linked to scientific developments • Integrated care of patients(disease management) • Less importance of health centers • Mix between health (PHC, Hospitals and LTC) and social care • Integrated Quality programs Q

23. 3. New Systems ofproviding of HealthCare • Change as organizations basis • From “making things” better to “making better things”. • Knowledge organizations • Influence of the center on • the society Increasing importance of providers’ satisfaction (change in recognition criteria) Q

24. 5. Future of the Quality programs • Common language shared by patients, professionals, managers, providers and administration

25. IHC TURP QUE Study Brendt James 1999

26. IHC TUPR QUE Study Brendt James 1999

27. Outcomes chain:TUPR costs Cost Retrograde pyelograms Length of stay Day of admit surgery Foley catheter management Perceived risk of obstruction from blood clots Brendt James 1999

28. Future 1980-85 1995-00 2002-05 2005-08

29. Some questions for discussion • What are the most effective ways to develop the new QI stage in Europe ? • How ca we ensure that patient/citizens´ agenda is accomplish? • What are the advantages and disadvantges of government leadership ? • Regional versus national versus European versus global approach ?