Frank RademakersHoofdgeneesheer, UZ Leuven

Accreditering van ziekenhuizen en Kwaliteitsverbetering

Symposium Orde van Geneesheren AntwerpenZaterdag 4 Mei, 2013

Patient Organization• Patient Safety

• Access and Continuity to Care

• Patient and Family Rights

• Assessment of Patients

• Care of Patients

• Anesthesia and Surgical Care

• Medication Management and Use

• Patient and Family Education

• Quality Improvement and Patient Safety

• Prevention and Control of Infections

• Governance, Leadership and Direction

• Facility Management and Safety

• Staff Qualifications and Education

• Mgmt of Communication and Information

JCI accreditation standards for hospitals, 3rd (4th)

Edition

QPSMaatsch

MCI

mede -werkers

QPSQ BSC

RvB

JCI standards in the INK model

Verbeteren en vernieuwen

Governance,Leadership

andDevelopment

QPSmede -

werkers

QPSptenPFE

Middelen

(zorg)processen

IPSGACCPFRAOPCOPMMU

(Eind)resultaten

QPSPCI

Organisatie Resultaat

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

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Quality from the Patient’s Perspective• Keep me safe• Heal me• Be nice to me

In that order!

Safety + quality + satisfaction = Excellent Care

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

Health Care Manage Rev, 2009, 34(3), 262-272

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

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 fine-tuning 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.

Circulation. 2013;127:1169-1172

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 self-assessment,” which must be “proportionate to a demonstrable contribution to the improvement in regulation and the ultimate goal of improvement in the quality of healthcare.”

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Typical Effort

Improving Clinical Practice Patterns

DataCollection

DataReporting

DataAnalysis

StrategyDevelopment

& Deployment

Leveraging automated data reduces manual chart review and allows increased time for analysis and problem solving

– the key to improving care!

Ideal Effort

Premier Tools Are Designed to Shift the Data Collection Effort Curve

BMC Health Services Research 2012, 12:329

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

Dr. Foster

Maatschappelijk kader

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

© 2007 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.

Ziekenhuisbrede mortaliteit

Copyright© 2003 Institute for Healthcare Improvement

© 2008 Institute for Healthcare Improvement

Zorgprogramma concept

Homogene doelgroep

van patiënten

BehandelingsModule 1

Diagnostische Module 1

RevalidatieModule 1

Follow up Module 1

Kwaliteitsvolle outcome

AC’s

Diagnostische Module ..

BehandelingsModule …

RevalidatieModule …

Follow up Module …

Picker Institute

Maatschappelijk kader