Quality Management Brigitte Domittner Gesundheit Österreich GmbH

Quality Management

Brigitte DomittnerGesundheit Österreich GmbH

Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality reporting

Topic Points








Gesundheit Österreich GmbH, Vienna

Organisation Status

Limited company owned by the Federal State of Austria

State is represented by the Austrian Ministry of Health

Non profit organisation

Independent in our scientific work

Legal Basis

• Federal Law for establishing “Gesundheit Österreich GmbH”

• Federal Law on Quality for Health Services for establishing BIQG

• Health Promotion Law for establishing Fund for a Healthy Austria (FGÖ)

Main tasks

“Think-Tank” for the Austrian Health Care System. Supporting Ministry of Health, provinces and other

stakeholders in preparing policy briefs, statutory regulations, etc.

Scientific research and analysis Provision of information for nationwide planning,

regulation, governance and (economic) evaluation in health care

Health Promotion and Preventive Health Development, implementation and evaluation of a

nationwide quality system. Participation in national and international projects and

working groups

Topic Points


Definition and evolution of Quality Total Quality Management





Definition of quality

Origin: Latin quālitās “of what sort”1

= “the standard of something as measured against other things of a similar kind; the degree of excellence of something”1

Informal: quality = good quality

Individual judgment of quality depends on various aspects, e.g. experience, education, environment

1www.oxforddictionaries.com

Quality specifies …

... the extent to which a product (good or service) meets the existing requirements/ standards.

In a nutshell: Evidence of good quality is...

... when the customer returns and not the product!

Evolution of Quality

Evolution of Quality I

Finding mistakes/errors

External assessment/control

Culture of mistrust

Inspecting the past

Evolution of Quality II

Looking into the past and plan for the

future

avoid mistakes

personal responsibility / ownership

culture of trust

Evolution of Quality III

Systematic fulfillment of customer requirements

Evolution of Quality IV

Participation of all members of an organization

Topic Points



Total Quality Management Quality Management Systems used in health care

organizations





» Organization wide management philosophy for continuously improving the quality of products / services and its processes

» Continuously quality improvement is the responsibility of everyone who is involved in the production or use of the products or services offered and hence is interested in its quality

Source: Øvretveit, (2000): Total quality management in European healthcare

Who is interested in quality?

Customer satisfactory quality of received product / service

Employees workplace satisfaction, career opportunities ...

Owner maximum created value

Supplier long-lasting business relationship

Society responsible and sustainable behaviour


» Organization wide management philosophy for continuously improving the quality of products and processes

Main components:» Focusing on consumer (and suppliers)» Analysing processes» Working in quality project teams» Systematically analysing quality problems, planning change

und evaluating the results» Using data to identify and analysing problems and

evaluating the results » Implementing change

Source: Øvretveit, (2000): Total quality management in European healthcare

Topic Points









Selected Systems:

» International Organization for Standardization – ISO

» European Foundation for Quality Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und Quality in Healthcare - KTQ


Selected Systems:





International Organization for Standardization (ISO)

» 1946: Meeting of delegates from 25 countries at the Institute of Civil Engineers in London

subject: ‘to facilitate the international coordination and unification of industrial standards’

» 1947: Creating the International Organization for Standardization

» 2012: ISO is a network of national standards institutes from 163 countries

» 2012: Over 19 000 International Standards covering almost every aspects of technology and manufacturing

Source: www.iso.org

ISO 9000 ff Quality Management

» Originally developed for the industry » Increasing use of standards in other areas (e.g. healthcare)» 2000: General revision and simplification of the ISO 9000

series (=Quality Management)

There are many standards in the ISO 9000 family, e.g:» ISO 9000:2005 - covers the basic concepts and language» ISO 9001:2008 - sets out the requirements of a quality

management system = base for certification» ISO 9004:2009 - focuses on how to make a

quality management system more efficient and effective» Current: Review of a European Standard for health care

services – requierements based on EN ISO 9001:2008

Source: www.iso.org

ISO Model of a process-based quality management system

Source: www.iso.org

ISO Quality Management Principles

Source: www.iso.org

ISO - Certification

» ISO develops International Standards and does not itself certify organizations

» External certification bodies perform the certification

Procedure: 1. Preliminary Audit (optional)2. Documentation Review3. External audit by an external certification 4. Issue of certificate valid for 3 years 5. Surveillance Audits internal auditing by trained internal

staff every year6. Certification Renewal

Source: www.iso.org

Certification versus Accreditation

Certification» written assurance (the certificate) by an independent

external body that processes or products conform to the requirements specified in the standard

Accreditation» Is a formal recognition by an accreditation body that a

person or institution is competent to carry out the certification in specified business sectors (= certification of the certification body)

» Terms accreditation and certification are often used incorrectly synonyms

Source: www.iso.org


Selected Systems:





European Foundation for Quality Management – EFQM

» Founded in 1989 by 14 European organisations, in order to increase the competitiveness of European organisations

» Not-for-profit membership foundation based in Brussels

» Creater of „The EFQM Excellence Model“

» The aim of the Model is to improve performance in order to reach „Excellence“

» 2012: more than 30 000 organisations in Europe use the Model

» Provide training, assessment tools and recognition for high performing organisations EFQM Excellence Award

Source: http://www.efqm.org

European Foundation for Quality Management – EFQM

Source: http://www.efqm.org

Detailed information in a separate presentation!


Selected Systems:





Joint Commission International - JCI

Joint Commission on Accreditation of Healthcare Organizations - JCAHO»Founded in 1951»Independent, not-for-profit organization»Define quality standards specially tailored for health care facilities »focuses on safety quality of medical services, patient and employee satisfaction»All processes are assessed (from patient registration, examination, treatment up to the transfer and discharge of a patient)»Accredits and certifies more than 19,000 health care organizations and programs in the United States»The whole organization, not just individual departments are being evaluated

Source: www.jointcommissioninternational.orgwww.jointcommission.org

Joint Commission International - JCI

Joint Commission International – JCI

» Created in 1994

» Implements the goals of the JCAHO at an international level

» Supports health care organizations through accreditation, education and technical assistance

» Accreditation of an organization: Is a recognition given to the healthcare organization, which meet the JCI standards

» JCI has a presence in organizations inmore than 90 countries

Source: www.jointcommissioninternational.orgwww.jointcommission.org


Selected Systems:





The Cooperation for Transparency und Quality in Healthcare - KTQ» initiated in 1997 by the German federal chamber of physicians

(BAeK) and the federal associations of various health insurance funds. Later joined by the hospital federation and the nursing council

» Is an organization which offers quality management certification for health care organizations

» Mission is to strengthen transparency in the performance of hospitals through providing comprehensible information to all concerned, including patients (quality report)

» KTQ analyzes and reviews medical, nursing and administrative processes

» Certifies health care organizations

Source: www.ktq.de

The Cooperation for Transparency und Quality in Healthcare - KTQ

» 1. Self-assessmentSelf-assessment of the organization based on the KTQ catalog . Describes the present situation, identifies room for improvement and establishes inter-departmental communication structures

» 2. External assessment (site visits)External assessments on site though qualified KTQ visitors

» 3. Quality report and issue of certificateScore higher than 55% in external assessment issue of a KTQ certificate (valid 3 years)

Source: www.ktq.de

(Certified) QMS - what could be the benefits?

e.g.:

» Optimized work processes

» overall quality improvement

» Marketing Tool

» Feedback from experienced external auditors/visitators

» Increased patient safety

» Increased patient satisfaction

» Optimized existing resources

» ...

(Certified) QMS - what could be the disadvantage?

e.g.:

» Higher costs to health care

» Added bureaucracy

» Time consuming

» Not being very practical for the organizations (ISO)

» Focusing primarily on processes and structure, less on outcome

» Implementation of standards are too lenient

» Process does not end with the final implementation and certification system needs maintaining without an final end

» …

Topic Points





Continuous Quality Improvement Regular reporting on the quality systems in Austria’s

hospitals and rehabilitation centres: The Quality Platform www.qualitaetsplattform.at


Continuous Quality Improvement

» Based on the Japanese philosophy of “Kaizen”

» Kaizen means “good change" , „change for the better“

» Never-ending efforts for improvement (continuous learning from mistakes, organisational learning)

» Involving everyone in the organization (all hierarchy level, from the CEO to the lowest level workers)

» Process oriented rather than outcome

From small steps to big results

改善

Kai

Zen

PDCA-Cycle (W.Edward Deming)

Quality

Management

System

Continuous Quality

Improvement

Effects of Continuous Quality Improvement

» Detects resources and synergies

» Optimizes workflows /processes and systems

» Improves the product / service and customer satisfaction

» Optimizes the use of resources

» Supports skills, creativity and commitment of the employees

» Improves team work and corporate culture

» BUT can also increase the “pressure to perform” for employees

… rowing is not enough!

Topic Points






Regular reporting on the quality systems in Austria’s

hospitals and rehabilitation centres: The Quality Platform www.qualitaetsplattform.at


The Quality Platform: www.qualitaetsplattform.at

The Quality Platform: www.qualitaetsplattform.at

Project goals:» Regular, nationwide quality reporting on key indicators for

quality structures and processes in Austrian hospitals Benchmarking & incentive to build capacities

» Sharing information about various projects community of practice

» Data collection via an access-protected website: www.qualitaetsplattform.at

structure database project database

Development of „The Quality Platform”

» until 2004: previous project www.qbe.at - no report published

» 2008, 2009: Evaluation and revision of the previous questionnaire (How should the report be designed, What kind of information should be in it?) Interviews, questionnaire survey, evaluation workshops, expert panelsGoal: questionnaire about structures and instruments of quality work in Austrian health care institutions

» 2010: Completing the questionnaire, programming the new website and launching the new quality platform at a national quality conference

General Framework

Contracting authority: » Federal Health Agency (Bundesgesundheitsargentur)

Policy framework “Quality reporting”» The Act on Health Care Quality

(Gesundheitsqualitätsgesetz)» Austrian Quality Strategy (Qualitätsstrategie)» 2011: Amendment of Law on Hospitals

(Krankenanstaltengesetzt) mandatory participation (before participation was voluntary)

Topic Points








The Quality Platform: structure database

Main content points» General description» Structural embedment of quality work» Quality Management Models » Quality work

Indicators - structure database

Structural embedment of quality work» Mission statement» Quality strategy» Quality Assurance Commission (staffing, internal regulations)» Coordination of quality work (organisation, staffing,

qualification)» Quality management models (ISO, EFQM, CJ)» Quality work

o Processes/Standardso Admission/Discharge procedureso Operative managemento patient-orientation

Rights of patients (information, trainings) Patient satisfaction survey (topics of questionnaire, intervals,

results)

Indicators - structure database

o Employee-orientation Employee satisfaction survey (topics of questionnaire,

intervals, results) Structured staff appraisal advanced training (documentation, coordination) workplace health promotiono Suggestions and complaints (survey method,

handling, analysing, employee suggestion system)o External quality-projectso Patient Safety and Risk Management (instruments,

reporting systems organisation, staffing, qualification)o Continuous Quality Improvement

Example for evaluation graphic

In how many departments there are defined contact persons for risk management? (n = 82)

Response: in all/in many/in some departments

Example for evaluation graphic

Quality models in Austrian hospitals > 80% of KH have a Quality Model implemented or a planning to do so

The Quality Platform: project database

» Name of the project

» Contact person

» Timeframe for the project

» Brief description of the project

» Target group

» Project orientation (patient,

employees, relatives, public...)

» Evaluation

Benefits of „The Quality Platform“

» Transparency: National overview of structures, tools and projects in hospitals and rehabilitations centres

» Benchmarking: the individual organization can benchmark itself with the Austria-wide results

» Automated analysis and download their own data (eg internal reports)

» Networking, information and experience for members

» Information section on the website of the quality platform (link collection, downloads, etc.)

Other Initiatives

» Nationwide uniform survey on patient satisfaction across sectors

» Austrian Inpatient Quality Indicators – A-IQI

„Evidence of effective change +

Effective implementation method +

Supportive environment and infrastructure =

Improved quality“

Source: Øvretveit, John (2009): Does improving quality save money? A Review of Evidence of which Improvement to Quality Reduce Costs for Health Service Providers. The Health Foundation, London

Thank you for your attention!

Documents

Quality Management Brigitte Domittner Gesundheit Österreich GmbH