Transcript JCQHC - ISQua
“Quality Sustainability” Project
of Japan Council for Quality Health Care (JCQHC) International ISQua Conference Rio, Brazil, 6 October 2014 Yuichi Imanaka, MD, PhD Director / Board Member Japan Council for Quality Health Care Professor, Kyoto University School of Medicine
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BACKGROUND
> What is JCQHC > Impact of Accreditation 2
JCQHC Japan Council for Quality Health Care
What is JCQHC ?
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JCQHC’s Mission
To contribute to the improvement of the health and welfare of the people by improving healthcare quality and ensuring trustworthy health care system as a neutral, scientific, third-party organization 4
JCQHC History
In 1995, JCQHC was established through collaboration of the Ministry & the Japan Medical Association . Also from hospital and professional associations Our Hospital Accreditation is Voluntary There is No linkage to reimbursement
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About 2,500 hospitals JCQHC (about half of the total hospital beds in Japan) 500 are accredited by surveys /year 5
JCQHC has Multiple Functions
Hospital Accreditation to improve the quality of hospital care Patient Safety Promotion to promote patient safety through networking and professional learning among accredited hospitals No-Fault Compensation System on Obstetrical Adverse Events to compensate childbirth cerebral palsy, and to improve the quality of obstetric care through RCA on adverse events EBM & Clinical Practice Guidelines; “MINDS” to distribute Clinical Practice Guidelines & improve their Q National Database of Medical Adverse Events to prevent errors/accidents and improve patient safety Near miss Event in Pharmacy 6
Hospital Accreditation Patient Safety Promotion (PSP) To improving the quality of health care and medical safety Project to Collect and Analyze Pharmaceutical Near-Miss Event Information Project to Collect Medical Near-miss /Adverse Event Information The Japan Obstetric Compensation System for Cerebral Palsy Medical Information Network Distribution Service (MINDS)
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“QUALITY SUSTAINABILITY” PROJECT
> Drivers Mission, Vision, Reviewing Social Impacts & Needs > Development > Key Values, Core Dimensions, Framework > Field Actions 8
Sustainability of Quality Healthcare System drivers for a new project
The Mission of JCQHC to sustain the quality of the healthcare system
reviewed accreditation impacts and social needs
Reform Needs for Greater Efficiency
Strong trend of cost containment due to government finance & super-aging of the society
Reform Needs for Sustaining Quality
Regional Disparity in Quality being visualized
Reform Needs for Regional Approach
Strategic Design for Resource Re-Allocation & Networking/Collaboration under limited resources 9
The New Project In this context,
We have developed a new project to evaluate and support already-accredited hospitals
aiming at a stronger strategic management basis for “sustainability” of high quality care .
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Development & Application
formed multidisciplinary team, including: Quality and Safety Experts, Clinical Experts Administration/Management Experts Organizational Reform Experts Finance Experts Policy Experts developed an evaluation framework based upon literature review, case studies, expertise knowledge, & interactions with hospitals and professionals. 11
core dimensions (1/2)
In addition to the whole-system approach to quality and safety of hospitals, we introduced
Regional Axis
to look into healthcare
"demand and supply in the region“
Provider Resources in the region
(current & future) Population Structure Time Axis
to look into the
future planning
also back into the history of hospital performance and management & 12
core dimensions (2/2)
Strengthening the Vision
Review
the mission & the internal/external environment of the hospital, etc
Sharing the Vision
staff involvement all through the reform process throughout the organization
Embedding the vision into activities
the Management Cycle the Future Planning 13
Assess
(quantitatively & in-depth):
medical care achievement
quantitatively
supply structure stability
clinical discipline/department
organizational culture
by each
professional growth
for quality and sustainability, including
aspects
financial achievement
short- & mid-term plans
health care provision, organization and finance including 14
財務の成果 MO SP EP MV HA ビジョン バリュー FO 15
Components of Framework
HA Historical Achievement MV Mission/Vision/Values EP External and Internal Environment Grasp and Planning HR Human Resources and Organizational Management PS Processes and Systems for Quality, Safety and Efficiency MO Medical Care Achievement/Output FO Financial Achievement/Output 16
財務の成果 MO SP EP MV HA ビジョン バリュー FO 17
key values
"Responsiveness to patient and community needs"
is regarded as vitally important, in addition to internal processes of assurance and improvement in quality, safety and efficiency.
"Quantitative approach"
is also employed and covers numerical data analysis of
medical
care achievement,
financial
output and
regional
demand and supply.
"Multi-level multidisciplinary teams approach"
was designed in phases of pre- and post-survey analysis, on-site surveys, interactions with hospitals, validation panels and follow-ups. 18
Regional Variation in Quality
Warning Signs !
to the health care system
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Variations in In-Hospital Mortality in AMI Patients by Municipality
0,4 0,3 0,2 0,1 Observed Risk-adjusted 0,0 Kyoto University - Dept. Healthcare Economics & Quality Management
MUNICIPALITIES
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Variations in All-Cause Readmission in AMI Patients by Municipality
0,4 0,3 Observed Risk-Adjusted 0,2 0,1 0,0 Kyoto University - Dept. Healthcare Economics & Quality Management
MUNICIPALITIES
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Proportion of Stroke Patients 0.16
,16 ,14 ,12 ,10 ,08 ,06 ,04 ,02 ,00 Kyoto University - Dept. Healthcare Economics & Quality Management
Administered t-PA MUNICIPALITIES
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Proportion of Patients who had undergone Rehabilitation during Hospitalization
,40 ,30 ,20 ,10 ,00 1,00 ,90 ,80 ,70 ,60 ,50 Kyoto University - Dept. Healthcare Economics & Quality Management
MUNICIPALITIES
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1,00
Proportion of “Ischemic Stroke with Atrial Fibrillation”
,90
Patients who were administered Warfarin
,80 ,40 ,30 ,20 ,10 ,70 ,60 ,50 ,00 Kyoto University - Dept. Healthcare Economics & Quality Management
MUNICIPALITIES
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Professional Activities
Policy Approach
Healthcare Quality
Regional Systems
JCQHC Approach for the national system
We plan to
disseminate “best practice and knowledge”
on improvements by multiple types of media and seminars. In addition, based on the vivid recognition of structures of problems in healthcare systems, we plan to
put forward “policy proposals”
for nationwide quality and sustainability.
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Importance of Regional Perspective
Japanese healthcare system is composed of public and private providers, and the government is not in the position to control everything.
Professional input is very important in restructuring the system.
Regional optimization should be aimed at through
professionally-driven collaboration
of stakeholders in each region.
Individual provider organizations should achieve their role
as integral part of the regional system
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JCQHC Japan Council for Quality Health Care
Photos
from the Project
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Assessment Phase
Reviewing & Sharing the Vision & Future Plan
Summary
Beyond accreditation, a new system has been developed & started for
“sustainability”
for quality health care, supporting in-depth management and regional perspective. This system is aimed & expected to improve individual
hospitals
and the
national healthcare system
reforms. for sustainability of quality care in the face of impending drastic healthcare 41
Thank you very much
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16-19 Oct. 2016, ISQua in Japan
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JCQHC Japan Council for Quality Health Care
Impact of Accreditation
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Change in IC score* by accreditation status
(*infection control practices following guidelines)
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IC Score
55 Newly Accredited Effect of Obtaining Accreditation Accredited before 2004 50 Non-Accredited Prospective, Quasi-experimental design using panel data 2004 2005 — ■ — — ▲ —
Am J Infect Control
2008;36(3):212-219 — ● — Accreditation
2004 2005
+ + + 45
- Hospital Director Survey Areas which Accreditation Impacted No Smoking Policy and plocedure for practice and task Physical Restraint Hospital directors perceived the impact It is because a new health 86.5% 82.7% in Pt Safety & Right areas 72.6% 72.3% 71.9% Clear Message for Patients Infection Control Practice protocol Infective Wastes Handling 71.4% 71.3% 70.6% 0% 20% 40% 60% 80% 100% Percent of hospitals who confirmed Accreditation Impacted their Hospital.
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- Hospital Director Survey Accredited vs Non-Accredited hospitals Despite some gaps, Non-accredited hospitals also perceived the impact in Pt Safety & Right areas Physician Orders 47
Impact of JCQHC Accreditation: Review of Evidence - Summary • • The Research Evidence suggested: Hospital accreditation impacted practices particularly in Patient Safety and Patient Right areas Hospital accreditation impacted also Non accredited hospitals , probably through the hospital accreditation standard getting the de fact standard for the whole hospital/health care arena 48
For Future Directions of Accreditation • • • • More Interactive, more Value-creating survey, more effectively fostering CQI based on professional autonomy (best practice diff ., etc ) More direct values for Patients (participation, provider choice, etc.) More focus on the Hospital Service Region (not only a hospital) To support more explicitly “Management” (quality/safety/resources/finance/ w/visionary leadership, etc.) for sustainability and growth 49