Quality Management Brigitte Domittner Gesundheit

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Quality Management Brigitte
DomittnerGesundheit Österreich GmbH
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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
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

3
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
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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Gesundheit Österreich GmbH, Vienna
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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)

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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

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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
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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Definition of quality

• Origin Latin qualitas of what sort1
• the standard of something as measured against
  other things of a similar kind the degree of
  excellence of something1
• Informal quality good quality
• Individual judgment of quality depends on various
  aspects, e.g. experience, education, environment
• 1www.oxforddictionaries.com

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Quality specifies
... the extent to which a product (good or
service) meets the existing requirements/
standards.
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In a nutshell Evidence of good quality is...

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

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Evolution of Quality
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Evolution of Quality I

• Finding mistakes/errors
• External assessment/control
• Culture of mistrust

• Inspecting
• the past

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Evolution of Quality II

• avoid mistakes
• personal responsibility / ownership
• culture of trust

• Looking into
• the past and
• plan for the future

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Evolution of Quality III
? Systematic fulfillment of customer requirements
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Evolution of Quality IV
? Participation of all members of an organization
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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
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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Total Quality Management

• 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
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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

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Total Quality Management

• 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
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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
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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Quality Management Systems used in health care
organizations

• 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

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Quality Management Systems used in health care
organizations

• 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

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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
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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 90002005 - covers the basic concepts and
  language
• ISO 90012008 - sets out the requirements of a
  quality management system base for
  certification
• ISO 90042009 - 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 90012008

Source www.iso.org
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ISO Model of a process-based quality management
system
Source www.iso.org
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ISO Quality Management Principles
Source www.iso.org
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ISO - Certification

• ISO develops International Standards and does not
  itself certify organizations
• External certification bodies perform the
  certification
• Procedure
• Preliminary Audit (optional)
• Documentation Review
• External audit by an external certification
• Issue of certificate ? valid for 3 years
• Surveillance Audits ? internal auditing by
  trained internal staff ? every year
• Certification Renewal

Source www.iso.org
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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
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Quality Management Systems used in health care
organizations

• 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

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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
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European Foundation for Quality Management EFQM
Detailed information in a separate presentation!
Source http//www.efqm.org
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Quality Management Systems used in health care
organizations

• 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

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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.org www
.jointcommission.org
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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.org www
.jointcommission.org
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Quality Management Systems used in health care
organizations

• 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

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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
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The Cooperation for Transparency und Quality in
Healthcare - KTQ

• 1. Self-assessment
• Self-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 certificate
• Score higher than 55 in external assessment ?
  issue of a KTQ certificate (valid 3 years)

Source www.ktq.de
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(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
• ...

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(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

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Topic Points

• Introduction Gesundheit Österreich GmbH
• Definition and evolution of Quality
• Total Quality Management
• Quality Management Systems used in health care
  organizations
• Continuous Quality Improvement
• Regular reporting on the quality systems in
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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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

? ?
Kai
Zen
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PDCA-Cycle (W.Edward Deming)
Continuous Quality Improvement
Quality Management System
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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

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rowing is not enough!
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Topic Points

• Introduction Gesundheit Österreich GmbH
• Definition and evolution of Quality
• Total Quality Management
• Quality Management Systems used in health care
  organizations
• Continuous Quality Improvement
• Regular reporting on the quality systems in
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

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The Quality Platform www.qualitaetsplattform.at
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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

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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

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General Framework

• Contracting authority
• Federal Health Agency (Bundesgesundheitsargentur)
• Policy framework Quality reporting
• The Act on Health Care Quality (Gesundheitsqualitä
  tsgesetz)
• Austrian Quality Strategy (Qualitätsstrategie)
• 2011 Amendment of Law on Hospitals
  (Krankenanstaltengesetzt) ? mandatory
  participation (before participation was
  voluntary)

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Topic Points

• Introduction Gesundheit Österreich GmbH
• Definition and evolution of Quality
• Total Quality Management
• Quality Management Systems used in health care
  organizations
• Continuous Quality Improvement
• Regular reporting on the quality systems in
  Austrias hospitals and rehabilitation centres 
  The Quality Platform www.qualitaetsplattform.at
• Detailed Information about the questionnaire for
  quality reporting

51
The Quality Platform structure database

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

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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
• Processes/Standards
• Admission/Discharge procedures
• Operative management
• patient-orientation
• Rights of patients (information, trainings)
• Patient satisfaction survey (topics of
  questionnaire, intervals, results)

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Indicators - structure database

• Employee-orientation
• Employee satisfaction survey (topics of
  questionnaire, intervals, results)
• Structured staff appraisal
• advanced training (documentation, coordination)
• workplace health promotion
• Suggestions and complaints (survey method,
  handling, analysing, employee suggestion system)
• External quality-projects
• Patient Safety and Risk Management (instruments,
  reporting systems organisation, staffing,
  qualification)
• Continuous Quality Improvement

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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
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Example for evaluation graphic
Quality models in Austrian hospitals gt 80 of KH
have a Quality Model implemented or a planning to
do so
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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

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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.)

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Other Initiatives

• Nationwide uniform survey on patient satisfaction
  across sectors
• Austrian Inpatient Quality Indicators A-IQI

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• 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
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Thank you for your attention!