Quality Improvement a Policy Strategy - BMJaws-cdn.internationalforum.bmj.com/pdfs/2016_H1.pdf ·...
-
Upload
nguyenthien -
Category
Documents
-
view
221 -
download
3
Transcript of Quality Improvement a Policy Strategy - BMJaws-cdn.internationalforum.bmj.com/pdfs/2016_H1.pdf ·...
Quality Improvement – a Policy Strategy
Britt Wendelboe, Acting CEO, The Danish Society
for Patient Safety
Jens Winther Jensen, Senior Fellow IHI
Britt
Jurans Triangle
Quality
improvement
Quality control
Quality planning
Britt
• Clinical registries – reseach and development
• Hospital accreditation
• Central planning of specialized treatments
• Patient safety agenda
Central elements in DK hospital qualityjourney in recent years
Jens
DK Clinical Registries
Total number 70
• 28 cancer registries including quality of palliative care and national screening programmes
• 12 intervention – related (e.g. intensive care, emergency medicine)
• 8 non-neoplastic elective surgery/orthopaedic surgery, gynaecology
• 8 major chronic disease
• 6 cardiovascular disease
• 3 psychiatry
• 3 obstetrics
• 3 pediatrics
• 2 emergency surgery
Jens
• ‘National Strategy for Quality Improvement in Health - Common
goals and action plan 2002-2006‘
• The Danish Health Care Quality Assessment Program (DDKM)
was a common model for assessing the quality of health service
• In 2005 The Danish Institute for Quality and Accreditation i
Healthcare (IKAS) was established
IKAS, The Danish Institute for Quality and Accreditation in Health Care
Jens
Canada (2004) 8%
Colorado/Utah (1999)
3%New York
(1991) 4%
Denmark (2001)
9%
UK (2000) 11%
Sweden (2008)
9%
France (2004) 9%
The Netherlands (2007) 6%New Zealand (2001) 13%
Australia (1994) 13%
The Journey: Patient Safety – Incidents with harm
Britt
Stakeholders took leadership
Danish Regions
Local Government Denmark
Danish Medical Association
Danish Nurses Organization
Trade union for social- and health care workers/assistants (FOA)
Association of Danish Pharmacies
Danish Patients
Disabled Peoples Organisations Denmark
Medical Device Industry The Danish Association of the
Pharmaceutical Industry (LiF)
The Danish Journey
Risk
Manage
ment
Effective
and timely
treatment
Dignity and
respect
The patient
as partner
1999 – 2001 – 2003 – 2005 – 2007 – 2009 – 2011 – 2013 – 2015 – 2016
The Patient’s book
10 good advice
Operation Life
All-or-none
Patient ambassadorsIn the patient’s footsteps
Dressed to be relative
Shared Decision
Making
The Safer Hospital
Program
New improvemnt
projects
Hallo Health Care
Triple Aim
‘Acceleration’ and a
national quality
program
Revision of
national reporting
system
Medication labels
- SADDanish AE Study - Physical
environment Learning sets
Safe Mental Care
The boards vision
International Milestones
Risk
Manage
ment
Effective
and timely
treatment
Dignity and
respect
The patient
as partner
1999 – 2001 – 2003 – 2005 – 2007 – 2009 – 2011 – 2013 – 2015 – 2016
The Patient’s book
10 good advice
Operation Life
All-or-none
Patient ambassadorsIn the patient’s footsteps
Dressed to be relative
Shared Decision
Making
The Safer Hospital
Program
New improvemnt
projects
Hallo Health Care
Triple Aim
‘Acceleration’ and a
national quality
program
Revision of
national reporting
system
Medication labels
- SADDanish AE Study - Physical
environment Learning sets
Safe Mental Care
The boards vision
IOM: To err
is human
IOM:
Quality
Chasm
IHI
100.000
Lives
Campaign
USA
Health
Foundation
Safer Patients
Initiative UK
Health
Foundation
Co-creating
Health
Kings Fund:
Silent
misdiagnosis
NEJM:
What
matters
to you?
IOM:
Improving
Diagnosis
NPSF:
Free
from
Harm
• Quality chasm – bundle concept – all-or-none
• Local engagement – celebrations – prof. pride
• Local real-time data
Operation Life 2007-2009Sepsis trolley with all
equipment for sepsis
treatment
Local real-time data
Ambitious overall goal – saving 3000 lives
Engagement
• “Close-to-the-clinic leadership”
• Improvement across the entire organization
• Transparency – ‘going naked’
Safer Hospital Programme 2010-2013
Close to the clinic leadership Hospital-level data presented at public boards
Joy from getting good results
“Social movements emerge as a result of the efforts of purposeful
actors (individuals, organizations) to assert new public values, form
new relationships rooted in those values, and mobilize the political,
economic, and cultural power to translate these values into action. They
differ from fashions, styles, or fads (viral or otherwise) in that they are
collective, strategic, and organized. The differ from interest groups in that
they focus less on allocating good than on redefining them – not only on
winning the but also changing the rules.” (Marshall Ganz*)
A movement of Quality Improvement
Ref: Ganz, Marshall: Leading Change – Leadership, organization, and social movements (2010), Harvard
Business Press
14
Jens
Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services.
International Public Management Journal, 13(1), 56–71.
Acc
red
itat
ion
Ben
chm
ark
ing
Tru
str
efro
m
Per
form
ance
man
agem
ent
Pay
by
DR
G
Pla
nn
ing
of
spec
ialt
y
fun
ctio
n
Cli
nic
ald
atab
ases
Nat
ion
alc
lin
ical
guid
elin
es
Pat
ien
tsa
tisf
acti
on
Competition xx xx xx xx
PatientCo-
production x
Command
andcontrolxx xx xx xx x x
Collaboration xx x x
Nature of national regulation of healthcare in Denmark
Mental Models of GovernancePUBLIC SERVICE MOTIVATION AND THE DELIVERY OF PUBLIC SERVICES
LeGrand’s
Categories
Choice
Voice
Mistrust
Trust
Derek’s Translation
Competition
Patient co-production
Command and
control
Collaboration
Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services.
International Public Management Journal, 13(1), 56–71.
System for improvements
Quality improvement
Innovation Control
Supervision
Excellent
quality
Quality
Unacceptable
quality
Health Care system
units
Control and command Cooperation and trust CompetetionUsers voice
Steering paradigms
Governance review of hospitals -Suggestions for procedures and rules simplification, May 2015
• An excess of generalised and standardised procedure-
and monitoring demands
• Employees use a lot of time on tasks which are
questioned by employees and their leaders
• Implementation overload – not the specific standard or
monitoring but the overall burden and trend
• Fear of not being accredited has produced a large
number of local quality standards
• Reduced local room for leadership
• Quality problems and standards are defined externally
• Leadership role reduced to implementation
Bent Hansen, President of Danish Regions
'Quality work must be simplified and focused.
The time has come to strengthen it by putting
the patient at the centre, rather than focusing
on compliance with a variety of standards.
Accreditation has been justified and useful,
but we move on. We need a few national
targets to be met locally with strong
commitment from the staff and with room for
local solutions.'
April 2015: Denmark to stop hospital accreditation
New Danish Quality Program
• National targets
• Systematic involvements of patients
• Leadership developmemt
• Systematic use of real-time data and data-driven
improvement work
• Transperancy of results
• Learning- and quality teams
Indicators
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Hospital
Hospital
MunicipalityHospital
Municipality Municipality
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
Local
goal
The national goals – Hierarchy of goals
Nat
ion
al L
evel
Loca
l lev
eL
The patient as the center
Improved efforts for
the chronically ill
and elderly patients
More coherent
continuity of care
Improved survival
and patient safety
Treatment of high
qualityRap
Rapid diagnosis and
treatmentRapIncreased patient
involvementRapMore healthy live
yearsRapMore effevtive
health care
Indicators Indicators Indicators Indicators Indicators Indicators Indicators
Hospital
GP
GP
Jurans Triangle
Quality
planning
Quality
improvement
Quality control
Quality
control
Quality planning
Quality
improvement
Drivers for policy change
• A Coalition for change: a new paradigm
• Building Will: Leaders, civil servants and public opinion,
exemplar sites
• Execution: Window of opportunity, policy suggestions
Britt