Comparing Quality Comparing Quality efforts across Europe: efforts across Europe: now and in the future 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
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Comparing Quality efforts across Europe: now and in the future Rosa Suñol, MD, Ph.D. Director, Avedis Donabedian Foundation Director AD Quality Chair.
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Comparing Quality efforts Comparing Quality efforts across Europe: now and in across Europe: now and in
the futurethe future
Rosa Suñol, MD, Ph.D.Director, Avedis Donabedian FoundationDirector AD Quality Chair. Fac. of Medicine. Autonomous University of Barcelona
Quality efforts in Europe. Quality efforts in Europe. First developmentsFirst 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
Common trends ofCommon trends ofthe first effortsthe 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
Present situationPresent situation Laws Public accountability (accreditation and certification) Total Quality management Cost of technology, clinical guidelines
and evidence based medicine Indicators Patients’ opinion
Legal framework Legal framework (80 -02)(80 -02)
Patients’ rights (access, general coverage, “good quality care”, )
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
Patients’ opinionPatients’ opinion Few countries with national data Few comparative initiatives
% PHC patients satisfied with the possibility of getting a suitable appointment (N=24.000)
71%
94%
77%
89%
78% 81%
62%
78%85%84%
Denm Germ Nethe Norw UK Belg F Belg W Switz Slove Spain
Wensing M, Vedsted P, Kersnik J et al. “Patient satisfaction with availability of general practice: an international comparison”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) 111-18International Journal for Quality in Health Care 2002 (14) 111-18
Present situationPresent 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 Less clinical involvement ??involvement ??
Last 5 years topicsLast 5 years topics
Clinical guide -lines Accreditation/ISO/ EFQM
Indicators
Technology assessment
Agenda for theAgenda for thefuture: coordination ?future: coordination ?
1. Globalization: European model
and sustainability 2. Health Agenda. Clients´ priorities and
participation3. New systems of providing health care
1. Globalization.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
QQ
2. Health Agenda. 2. Health Agenda. Clients: priorities in QI Clients: priorities in QI programsprograms
Patients’ Priorities / expectationsPatients’ Priorities / expectations(% patients with maximum score)(% patients with maximum score)
Questions % Punt. 7
Professionals are interested in solvingpatient’s problems.
88,2
The correct medication is delivered. 87,6
Personalized manner of treating patients. 82,2
No diagnostic errors. 80,5
Doctor dedicate sufficient time to patients. 79,0
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
2. Health Agenda. 2. Health Agenda. Clients Clients
QQ
2. Health Agenda. 2. Health Agenda. Clients participation 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
QQ
3. New Systems of3. New Systems ofproviding of Health Careproviding 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 programsQQ
3. New Systems of3. New Systems ofproviding of Healthproviding of HealthCareCare
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)
QQ
Common language shared
by patients, professionals,managers, providers andadministration
5. Future of the Quality5. Future of the Quality programs programs