What we have learned in 30 years? - ASIQUAS · What we have learned in 30 years? Rosa Sunoland...
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What we have learned in 30 years? Rosa Sunol and Andrea Gardini On behalf of the Udine ISQuA founders attendants www.fadq.org
Transcript of What we have learned in 30 years? - ASIQUAS · What we have learned in 30 years? Rosa Sunoland...
What we have learned in 30 years?
Rosa Sunol and Andrea Gardini
On behalf of the Udine ISQuA founders attendants
www.fadq.org
www.fadq.org
Chi siamo?
Che cosa ho appresoin 30 anni di qualità? (10 minuti a testa)
L’ international Society for Quality in Health Care
fu fondata ad Udine nel 1985 dopo un meeting dell’OMS
Bill Jesee, Agnes Jacquerie, Charle Shaw, Hannu Vuori, Rosa Sunol, Andrea
Gardini, Franco Perraro, Elma Heidelman, Lluis Bohigas, Evert Reerink
240 anni di evidenza empirica
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Diagnosi complessiva
Siamo stati tutti daccordo, dopo 240 anni complessivi di esperienza pratica e
di evidenze empiriche che i problemi non sono tanto definire e misurare le
visioni, le attese e gli standards ma sorgono nella gestione del cambiamento,
E’ importante sapere che la debolezza delle strategie di miglioramento non è tanto dalle strategie di per sè ma da come sono attivate a livello locale
Contesto
Pettigrew model 1985
Contenuti
Strategie attuative
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Ensure that patientinvolvement is notjust a pre-electionpromise or a tokengesture but is trulyharnessed forhealthcareimprovement
Policymakers and managers should involve patients
in defining, measuring and improving standards
of performance
Clinical professions should accept responsibility for professional accountability, self-regulation, clinical governance, and contribute to creating effective management systems
Clinicians must fully understand the importanceof this responsibility and its contributionto the quality of the health care system.
Culture
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Culture II
Organisations should develop a culture
of quality in which responsibility for qualitythreads throughout the organisation-bottom up to top down-
Quality must be everyone’s responsibility.
The culture of quality within an organisation cannot be built overnight but must be carefully constructed through education, discussion, and cooperative actions to achieve full organisational commitment
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Policy I
Theoretical models are important for a comprehensive view of the system
Avoid the distraction of relabelling and transient
fashions in quality; planning, organisation, direction and control require the same cycle of feedback and
improvement, whatever the label.
Beware rebranding committees, journals or associations, reinventing wheels and forgetting corporate learning.
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Policy II
Beware of envisaging technical solutions as a panacea for complex behavioural problems
Published clinical guidelines on their own may have little effect on clinical practice … if not applied
Performance indicators, while often fairly easy to establish, cannot function (and are often useless) without reliable,accessible, timely source data.
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Policy III
Health ministries and international donors should follow up on action plans that have resulted from major health system projects, often focussed on the improvement of quality..
They should evaluate the impact of policies and strategies and publish findings to promote learning and avoid replicating failures in other countries
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Incentives
Avoid perverse incentives; align financial, regulatory, professional, educational and public pressure on individuals and organisations
Beware of service strategies driven by healthcare insurers and purchasers rather than by evidence of effectiveness
Some emerging international evidence appears to indicate that decreased funding may not result in decreased quality based on data from quality indicators
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Institutions I
Integrate clinical practitioners in the quality management system
Beware of labelling an individual with total responsibility for quality (e.g. the quality officer) quality is every bodies’ business
Integrate working within and between teams, specialties and disciplines; errors and safety issues most often occur in communication and handover between shifts, teams and departments
Organisations and governments need quality leaders able to lead effectively for the creation of quality organisations that deliver quality care and that implement on-going quality improvement.
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Institutions II
Quality activities seem to be more effective at the department level
Move the organisation’s quality efforts to focus as closely as possible on the patient-provider interaction.
Patient centred care strategies are not widely systematized and more evidence is needed on how to implement them effectively in practice
Hospital managementleadership
Hospital qualitymanagementsystems
Departmentqualitymanagementsystems
Clinical effectiveness
Patients perception
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Relationships
Competition and overlapping between this systems counterproductive, confusing, and often destructive. It is also a feature of many health systems
Differentiate the responsibility, authority and interaction of healthcare regulators (to enforce basic safety in all institutions) and voluntary programmes (to promote continuous improvement and recognise excellence
Inspection
Opening permisions
Contracts
Accreditation,
ISO, Baldrige award,
EFQM model
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Resources I Clinicians need protected time to participate effectively in internal audit, quality improvement activities, peer review, and continuing education
Ministries and donors should agree realistic timescales for changing culture, behaviour and health systems; health reform may need years. Health reform needs ongoing, long term commitment
Universities and academics should introduce relevant knowledge, attitudes and skills related to quality and quality monitoring in undergraduate and postgraduate curriculum
Time is a treassure
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Resources II
.
Health ministries and insurers should avoid collecting and hoarding routine data related to quality which they do not use or share with the institutions which provided the reports
Managers and designers should ensure that data and information systems are integrated and accessibleto staff for multiple applications, including internalaudit and performance management
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Addressingchallenges
Journals and conferences should give more
attention to analysing and learning from past failures, or to scanning the horizon for future challenges
.
The Udine reunion of ISQuA founders suggests that the hierarchy of evidence in healthcare should acknowledge the power of systematic anecdote !!
In many countries, governments look for quick-fix solutions for health systems,achievable within the parliamentary life cycle. Rarely does that investment extend into systematic implementation, follow-up and evaluation of impactof the of the investment on quality of care.
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Il Modello per l’Eccellenza della European Foundation for Quality Management (EFQM)
F A T T O R I R I S U L T A T I
Leadership(10%)
Gestionedel Personale
(9%)
Politichee Strategie
(8%)
Partnershipe Risorse
(9%)
Processi(14%)
Risultatirelativi alPersonale
(9%)
Risultatirelativi ai
Clienti(20%)
Risultatirelativi alla
Società(6%)
Risultatichiave di
Performance(15%)
I N N O V A Z I O N E E D A P P R E N D I M E N T O
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www.fadq.org
THANK YOU !!
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