Transcript Dia 1 - Ordomedic

Accreditering van ziekenhuizen en
Kwaliteitsverbetering
Symposium Orde van Geneesheren Antwerpen
Zaterdag 4 Mei, 2013
Frank Rademakers
Hoofdgeneesheer, UZ Leuven
JCI accreditation standards for
hospitals, 3rd (4th) Edition
Patient
Organization
• Patient Safety
• Quality Improvement and Patient Safety
• Access and Continuity to Care
• Prevention and Control of Infections
• Patient and Family Rights
• Governance, Leadership and Direction
• Assessment of Patients
• Facility Management and Safety
• Care of Patients
• Staff Qualifications and Education
• Anesthesia and Surgical Care
• Mgmt of Communication and Information
• Medication Management and Use
• Patient and Family Education
JCI standards in the INK model
mede werkers
Governance,
Leadership
and
Development
QPS
Q BSC
RvB
QPS
(zorg)
processen
IPSG
ACC
PFR
AOP
COP
MMU
Middelen
Organisatie
mede werkers
(Eind)
resultaten
QPS
PCI
QPS
pten
PFE
QPS
Maatsch
MCI
Resultaat
Verbeteren en vernieuwen
Ervaring UZ Leuven met JCI accreditering
• Accrediteringstraject zeer positieve ervaring
• Vormt een hulp bij een gestructureerd veiligheidsbeleid
- identificatie van voor verbetering vatbare elementen
- belang van externe druk voor « change management »
- focus op prioritair in te voeren innovaties
• Motiverend voor medewerkers
=> Helpt zaken te realiseren, stimuleert de bredere CQI cultuur
Quality from the Patient’s Perspective
• Keep me safe
• Heal me
• Be nice to me
In that order!
Safety + quality + satisfaction = Excellent Care
8
Ervaring UZL met JCI accreditering : aandachtspunt
• Focus voornamelijk op patiëntveiligheid
- is essentieel onderdeel van kwaliteitsbeleid
« geen goede zorg zonder veilige zorg »
- maar volgt patiënt outcome eerder in functie van risico
vermindering dan kwaliteitsverbetering van geleverde zorg
« veilige zorg niet noodzakelijk goede zorg »
=> te complementeren door pathologie specifieke kwaliteits
opvolging
JCI accreditation standards for hospitals, 4th
Edition
• Inclusie opvolging pathologie specifieke proces / outcome
indicatoren uit JCI international library of measures
- Acuut myocardinfarct / Li hartfalen
- CVA
- Astma bij kinderen / pneumonie
- Perinatale zorg
- Surgical care improvement project (SCIP) : antibiotica en DVT profylaxis
- Hospital-Based Inpatient Psychiatric Services (HBIPS) : fixatie / isolatie
- Nursing-Sensitive Care : decubitus / valrisico
Maatschappelijk kader
Added Value = Quality/Cost
Certain adverse events, such as infections and decubiti, may be reduced
by preventive protocols that are reflected in accreditation standards,
whereas other events, such as failure to rescue and postoperative
respiratory failure, may require multifaceted strategies that are less easily
translated into protocols.
Health Care Manage Rev, 2009, 34(3), 262-272
Health Care Manage Rev, 2009, 34(3), 262-272
Accreditation and Regulation: Can They Help
Improve Patient Safety?
By Rebecca N. Warburton, PhD
Accreditation has been observed to be more effective in promoting good
safety practices than state-required error reporting or public awareness,
and in most hospitals, accreditation requirements are the primary driver
of safety efforts. In others, however, particularly those that are more
oriented to safety improvement and excellence in general, accreditation
requirements are viewed as a floor; staff at the Veterans Health
Administration explicitly set safety goals that exceed accreditation
requirements, and many hospitals have voluntarily implemented rapid
response teams and other optional enhancements to care.
AHRQ WebM&M April 2013
I'll conclude with some evidence-based recommendations to improve the
quality and safety benefits from regulation and accreditation. First,
regulators and accreditors need to become more aware of the costs and
effects of their actions. Changes need to produce net benefits, and the
most cost-effective changes should be adopted first. Second, they
need to improve their use of monitoring and evaluation of both
intended and unintended consequences, so that mistakes can be
swiftly corrected. Third, they need to do a better job of meaningfully
involving the actual clinicians who will be affected by new rules,
guidelines, and measures in their development; this would provide a
double benefit, both generating better standards and increasing
practitioners' appreciation of the beneficial role of accreditation and
regulation. Fourth, they should consider piloting changes (and finetuning them based on pilot results) before making them mandatory
system-wide. Health care is a very complex system, and it is difficult and
dangerous to assume that well-intentioned changes will always have the
predicted real-world effects.
Scrivens has explored some of these issues of regulatory burden, proof of
benefit, and effectiveness in a recent article regarding the British National Health
System. In it, she cogently reviews the issues that need to be considered in the
development of an effective regulatory system. Among these are included a
fundamental cost-effectiveness principle founded on the basis of demonstrable
evidence: The system “must operate within a restricted cost envelope,” and must
reduce “the administrative burden associated with both inspection and selfassessment,” which must be “proportionate to a demonstrable contribution to
the improvement in regulation and the ultimate goal of improvement in the quality
of healthcare.”
Circulation. 2013;127:1169-1172
Premier Tools Are Designed to Shift the Data
Collection Effort Curve
Typical
Effort
Ideal
Effort
Improving
Clinical
Practice
Patterns
Data
Collection
Data
Reporting
Data
Analysis
Strategy
Development
& Deployment
Leveraging automated data reduces manual chart review and allows increased
time for analysis and problem solving
– the key to improving care!
17
Standards are ubiquitous within healthcare and are generally considered to be
an important means by which to improve clinical practice and organisational
performance. However, there is a lack of robust empirical evidence examining
the development, writing, implementation and impacts of healthcare
accreditation standards.
BMC Health Services Research 2012, 12:329
BMC Health Services Research 2012, 12:329
Maatschappelijk kader
Dr. Foster
The small body of evidence available provides no consistent evidence
that the public release of performance data changes consumer behaviour or
improves care. Evidence that the public release of performance data may
have an impact on the behaviour of healthcare professionals or
organisations is lacking.
A basic assumption underlying the provision of report cards is that provider
choice is a rational decision. In other words, consumers prefer the
healthcare provider or health plan rated as the best.
Evidence that confirms this assumption is limited (Faber 2009; Kolstad
2009). However, several factors that influence the choice of consumers are
known, such as established relationships with local physicians, health plans
(Schwartz 2005; Hibbard 2009), hospitals, distance, and opinions of friends,
and family (Harris 2008; The King’s Fund 2010).
The Cochrane Library 2011, Issue 11
It is not possible to draw any conclusions about the effectiveness of
strategies to change organisational culture because we found no studies
that fulfilled the methodological criteria for this review. Research efforts
should focus on strengthening the evidence about the effectiveness of
methods to change organisational culture to improve health care
performance.
The Cochrane Library 2011, Issue 1
We only identified two studies for inclusion in this review, which highlights
the paucity of high-quality controlled evaluations of the effectiveness of
external inspection systems. No firm conclusions could therefore be
drawn about the effectiveness of external inspection on compliance with
standards.
The Cochrane Library 2011, Issue 11
Maatschappelijk kader
© 2007 Institute for Healthcare Improvement
• Respect
• Control/Autonomy
• Money
© 2007 Institute for Healthcare Improvement
The Quality Professional’s
Perspective
•
•
•
•
•
•
•
•
•
•
Do the Right Thing Right, the First Time
Continuous Process Improvement
Timeliness
Reliability
Efficacy
Availability
Affordability
Standardization
Freedom from Deficiencies
Customer Satisfaction
© 2008 Institute for Healthcare Improvement
View of a Health System Using the Whole System
Measures
Note that equity is not pictured in the figure. This important quality dimension
is measured by stratifying the Whole System
Measures, when possible, into subpopulations that differentiate by gender,
age, income, or racial groupings, for example.
© 2007 Institute for Healthcare Improvement
Ziekenhuisbrede mortaliteit
Copyright© 2003 Institute for Healthcare Improvement
© 2008 Institute for Healthcare Improvement
Zorgprogramma concept
AC’
s
Diagnostische Module 1
Diagnostische Module ..
Kwaliteitsvolle
outcome
BehandelingsModule 1
Homogene
doelgroep
van
patiënten
BehandelingsModule …
RevalidatieModule 1
RevalidatieModule …
Follow up Module 1
Follow up Module …
Maatschappelijk kader
Picker Institute