Transcript Kwaliteitssystemen in zorginstellingen

Peer review and visitatie
Dr.Cordula Wagner
NIVEL
www.nivel.nl
Definition
visitatie
• Systematic site-visits conducted by peers and
is aimed at improving the quality of patient
care.
• It is a doctor-led and –owned QA-activity,
meaning that physicians set standards,
conduct the surveys, formulate the
recommendations for improvement and
decide upon sanctions or corrective actions.
•
(Lombarts, 2003)
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The rise of visitatie
• Government direct policy to control volume and specialists income to
reduce health care expenditures (1987)
• Question of autonomy and accountability
• Late 80’s/early 90’s 20 of the 29 medical professional societies started
surveying their members in non-teaching practices
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Medical specialists
• Organized in partnerships
• Partnerships are the economic and
operational unit for professional
interaction
• Specialists strongly identify with their
group
• Speciality based visitaties correspond
with that perception
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Dutch visitatie model
Origin
First visitatie by specialty society of
surgeons in 1989
Owner Each specialty society administers and
executes its own visitatie program
Purpose Assure and improve quality of patient
care
Scope Specialist groups (partnerships)
Focus Practice management
Funding Department of Health
Lombarts, 2003
Dutch visitatie model
Survey
2-4 peers from different hospitals
team
Surveyors - respected colleagues
- at least 5 years in practice
- no existing compromising personal or
professional tie with colleagues
Standards discipline specific, some hospital broad
Visitatie - every 3-5 years
cycle
- site visit last 1 day
Selfself-evaluative questionnaire
assessment
Lombarts, 2003
Dutch visitatie model
Visitatie
process
- Paper evaluation prior to site-visit
- Site-visit: interviews, on-site
observation, review of some medical
records
Results
Report with recommendations
Evaluation
All reports are being checked by
specialty societies quality committee
Confidentiality Findings only for reviewed medical
specialists
Many share voluntarily with hospital
management
New contracts: selected results are
shared
Sanctions
No formal sanctions
Legal context Participation is required for reregistration
Lombarts, 2003
Questions
How is peer review organized in your
country?
What is the same?
What is different?
Do you agree with the definition
What is the situation in nursing homes?
What is the situation in home health?
ENQual workshop II