Standard of Care: Healthcare Quality

Standard of Care: Healthcare Quality ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Standard of Care: Healthcare Quality Standard of Care:HealthcareQuality. For this assignment you are inspire to provide some thought about the Standard of Care, its Origins and its implications in our normal live. The paper will be 4-5 pages long. Standard of Care: Healthcare Quality e77983.pdf 04738_teitelbaum_ppt_chap_11.ppt 04738_teitelbaum_ppt_chap_12.ppt e77983.pdf _teitelbaum_ppt_chap_11.ppt _teitelbaum_ppt_chap_12.ppt EUR/02/5037153 ORIGINAL: ENGLISH UNEDITED E77983 A background for national quality policies in health systems Charles D. Shaw Isuf Kalo 2002 ABSTRACT The improvement of quality is, for most countries, central to the reform of health systems and service delivery. All countries face challenges to ensure access, equity, safety and participation of patients, and to develop skills, technology and evidence-based medicine within available resources. The first part of this document outlines some of the values, forms and concepts which affect national approaches, together with the international influences of the Council of Europe, European Union and the WHO Regional Office. The second part offers a framework and principles for a national quality strategy. This gives examples of policy, organization, methods and resources which have been applied to the institutionalisation of quality by Member States. The appendices include a summary of recommendations from expert advisers on behalf of the Council of Europe and of WHO Europe. There is also a selfassessment tool to help identify existing mechanisms and future opportunities for quality improvements, as well as references to relevant publications and websites. Keywords QUALITY OF HEALTH CARE DELIVERY OF HEALTH CARE – standards OUTCOME ASSESSMENT (HEALTH CARE) QUALITY CONTROL NATIONAL HEALTH PROGRAMS POLICY MAKING EUROPE © World Health Organization – 2002 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page Acknowledgements ……………………………………………………………………………………………………………………….i Part 1: The context of quality …………………………………………………………………………………………………………1 Purpose……………………………………………………………………………………………………………………………………1 Better Systems; better care…………………………………………………………………………………………………………1 Part 2: Background for quality policy ……………………………………………………………………………………………..Standard of Care: Healthcare Quality 9 National values and priorities for quality……………………………………………………………………………………..9 National organization and institutionalization of quality………………………………………………………………12 Methods, techniques and tools for development of quality …………………………………………………………..19 Resources for quality improvement …………………………………………………………………………………………..29 Starting out and moving forward ………………………………………………………………………………………………31 Annex 1 Classification of quality concepts and tools ……………………………………………………………………..34 Annex 2 Self-assessment questionnaire ………………………………………………………………………………………..36 Annex 3 Recommendations of the Council of Europe…………………………………………………………………….40 Annex 4 WHO references on quality ……………………………………………………………………………………………43 Annex 5 References……………………………………………………………………………………………………………………45 Index…………………………………………………………………………………………………………………………………………51 Table 1. Examples of national policies for quality in Europe ……………………………………………………………..9 Table 2. Examples of current policy initiatives, Ireland……………………………………………………………………10 Table 3. Examples of legislation for quality in health care, general …………………………………………………..11 Table 4. Examples of national quality policy groups/councils…………………………………………………………..14 Table 5. Examples of national executive agencies…………………………………………………………………………..15 Table 6. Integrating quality agencies in Scotland and England, 2002 ………………………………………………..16 Table 7. Examples of reference centres for clinical guidelines and HTA……………………………………………17 Table 8. Appraisal of Guidelines Research and Evaluation (AGREE) project …………………………………….18 Table 9. Journals of national societies for quality in Europe …………………………………………………………….18 Table 10. Definitions of accreditation, licensure and certification……………………………………………………..20 Table 11. National accreditation programmes launched since 1995 in Europe ……………………………………22 Table 12. Features of collegial and regulatory systems ……………………………………………………………………22 Table 13. Some national standards projects ……………………………………………………………………………………24 Table 14. Some national measurement projects ………………………………………………………………………………25 Table 15. Some national improvement projects ………………………………………………………………………………27 Table 16. National initiatives for patients’ rights…………………………………………………………………………….28 Table 17. Some government guides to quality ………………………………………………………………………………..28 EUR/02/5037153 page i Acknowledgements This presentation of ideas on quality in health systems was suggested by Professor Isuf Kalo, Regional Adviser on Quality of Health Systems to WHO in Copenhagen.Standard of Care: Healthcare Quality The contents are drawn from countries around Europe, and edited into some semblance of structure by Dr Charles Shaw. The examples given are not intended to mean that others do not exist; we regret any such omissions – which could be remedied in a second edition. We are particularly grateful to the following for their helpful comments on drafts of this manuscript: Dr Marius Buiting, CBO Utrecht, Netherlands Professor Viktorija Cucic, School of Public Health, Belgrade, Yugoslavia Stiofan de Burca, Mid-Western Health Board, Limerick Professor Agnes Jacquerye, Université Libre de Bruxelles, Belgium Dr Ursel König, Klinik am Eichert, Goeppingen, Germany Dr Palmira Morkuniene, University Hospital, Vilnius, Lithuania Professor Franco Perraro, Udine, Italy EUR/02/5037153 page 1 Part 1: The context of quality Purpose The first part of this document aims to provide Ministers of Health, and other policymakers in WHO Member States, with background information on common definitions and issues surrounding quality of health systems and health care. The second part presents a background for a national programme for improving quality, based on research evidence and on experience from other countries in and beyond Europe. The definition and assessment of quality used to be left to technology, professionals and economists; now, in the context of health systems, it is increasingly the domain of patients, of a well informed public and electorate, and of a competitive market which compares performance with other countries. The growth of technology and information, the demands for transparency and public accountability, and the limits of financial and human resources oblige every Member State to describe and reform its health system according to internationally recognized standards of structures, process, performance and results. Better Systems; better care Priorities for quality Much of the research and development of quality in health care came from the developed countries, especially the United States, and focused on hospitals, high technology and voluntary self-regulation. But the first priorities in many countries are to develop basic health care, community services and public health. Here, quality programmes tend to be driven by government and statutory control. However, public, political and professional dissatisfaction with health services shows a global consensus. Concerns relate particularly to access and continuity of care, clinical effectiveness, patient safety, value for money, consumer responsiveness and public accountability. Thus the developed world has begun to shift attention towards preventive medicine, primary care, consumer involvement and more explicit regulation by government and funding agencies through managed care and health networks. The main reasons given by EU member and accession states to implement quality assurance strategies are (1): · Unsafe health systems; · Unacceptable levels of variations in performance, practice and outcome; · Ineffective or inefficient (overuse, misuse or underuse) healthcare technologies and/or delivery; · Unaffordable waste from poor quality; · User dissatisfaction; · Unequal access to healthcare services; · Waiting lists; EUR/02/5037153 page 2 · Unaffordable costs to society: · Standard of Care: Healthcare Quality Waste from poor quality. The language of quality No consensus exists on the definition of quality or how it should be measured, either in overall health systems or in population or individual health care. Different cultures have different values and priorities; for some, “goodness” means the provision of staff and facilities, for some it means equity and compassion, for others it means optimum clinical outcomes. The challenge for every country is to recognize these various legitimate expectations and to reconcile them in a responsive and balanced health system. However, according to a framework proposed by a group of authors in WHO/HQ in 2001, the quality of health systems is defined as the level of attainment of health systems’ intrinsic goals for health improvement and responsiveness to legitimate expectations of the population (2). Values The quality of health care is often debated by users, providers and purchasers, but the overall health of the population depends more on the quality of the health system including the country’s social, economic, educational and cultural environment. But the quality of health care provided to the population is also largely determined by models of financing, legislation and other regulatory mechanisms. There is general agreement that “quality” should be assessed from the viewpoints of major stakeholders (such as users, care providers, payers, politicians, and health administrators) and against explicit criteria which reflect the underlying values of a given society. The most commonly quoted elements of a “good” health system relate to Donabedian’s adaptation of the concept of input-process-output in industrial manufacturing. Structure – availability of human, financial, technical resources (investment): · How they are allocated in terms of time, place and responsiveness to the needs of populations (access); · Fairness in sharing costs and benefits (equity). Process – how the resources are applied (stewardship): · Use of time and resources (efficiency); · Avoidance of waste (economy); · Reduction of risk (safety); · Evidence-based practice (appropriateness); · Patient-focused care (continuity); · Public information (choice, transparency, accountability). Outcome – what results are achieved (performance): · Population health (health improvement); · Clinical outcome (effectiveness); · Meeting expectations of public and workforce (satisfaction); · Value for money (cost-benefit). EUR/02/5037153 page 3 It is not realistic to expect to concentrate on all of these values at the same time. Each country should define the strategic totality of values in quality (preferably in terms which could survive a change of government), and then define the operational priorities. Concepts of improvement A mechanical approach to “quality control” and inspection of inputs and processes is appropriate to machines and can produce static compliance with minimum standards. But it has been proven that it does not stimulate human behaviour towards a conscious dynamic improvement and often leads to blame and punishment, which do not motivate staff and managers in professionally led services. In the past twenty years, the concept of improvement of health systems has moved away from top-down control, compliance and punishment towards bottom-up development, self-regulation and incentives; quality measurement has shifted from resource inputs to performance outputs. Emphasis has moved from “quality control and assessment” to the definition of agreed and valid standards, systematic and reliable measurement of performance, implementing action for change, repeated measurement and continuous improvement in a cycle or upward-moving spiral. Standard of Care: Healthcare Quality Figure 1. The cycle of quality improvement Quality cycle Standards Targets Guidelines Expectations Measurement Survey Indicator Change Improvement Quality cannot be “inspected into” healthcare systems; improvement requires a quality culture to be shared by managers and staff, particularly the clinical professions which are most resistant to external control and regulation. Currently there is little evidence that regulatory systems have adopted the principles of continuous quality improvement (3), but there is also evidence that internal mechanisms of organizational and personal development on their own have repeatedly failed to ensure safety, efficiency, best practice and public accountability. Ideally, national quality improvement programmes would be subject to the same scientific evaluation as clinical technologies but in reality they rarely are – even though the methods exist for more robust examination (4). EUR/02/5037153 page 4 Several analyses of national health policy on quality development (5–8) have recognized a need for a collaborative balance between voluntary, independent peer review by health professionals (such as by clinical audit, governance and accreditation) and statutory, governmental control (such as by licensing, registration and inspection). The general conclusions were that statutory and voluntary quality systems should be coordinated with national or local government in order to ensure valid standards, reliable assessments, transparency and public accountability. For their part, the medical associations of Europe have committed themselves to encouraging the responsibility of health care providers in the process of continuous quality improvement (9). But so far there is little evidence that mechanisms designed for external regulation are effective routes to quality improvement, or that professional self-regulation ensures public accountability, or that the two goals can be achieved better by a single structure. Therefore it is clear that governments must work with independent bodies of users, health professionals, insurers and health politicians to improve the quality of health systems. A key aim of any national strategy for quality is therefore to identify and develop the common interests and partnerships between governmental and nongovernmental contributors. The environment of quality International environment In Europe, key intergovernmental contributors to policy on quality in health care are the Council of Europe, the European Commission and WHO Regional Office for Europe. Other influences are funding agencies, such as the World Bank and national development agencies, and crossborder market forces resulting from freedom of travel, insurance, trade and professional practice. Less formal networks also promote the generation and exchange of evidence and methods of quality improvement through international societies (such as for technology assessment (10), quality (11), and primary care (12) and the European Society for Quality in Healthcare (13)) and collaborations of professional and technical interests (such as the European Organization for Quality (14), the European Foundation for Quality Management (15), and the Cochrane collaboration (16)) Council of Europe The Council of Europe established a committee of experts on quality in 1995. This committee drafted a series of recommendations to health ministers (adopted in 1997) that the governments of Member States should establish a quality improvement system (17), meaning: Standard of Care: Healthcare Quality “To create policies and structures, where appropriate, that support the development and implementation of ‘quality improvement systems’, i.e. systems for continuously assuring and improving the quality of health care at all levels”. The resolution was based on the notion that receiving health care of good quality is a fundamental right of every individual and each community, that it is implicit in Article 11 of the European Social Charter on the right to the protection of health, and because Article 3 of the Convention on Human Rights and Biomedicine requires that Contracting Parties provide “equitable access to health care of appropriate quality”. The appendix to this resolution outlined 17 practical guidelines for a national quality improvement system (see Annex 3). EUR/02/5037153 page 5 European Union The mission of the Directorate General for Health and Consumer Protection is to “ensure a high level of protection of consumers’ health, safety and economic interests as well as of public health at the level of the European Union” (18). Although the delivery of health services is clearly the responsibility of individual states, the common agenda of transparency and consumer protection increasingly brings social, if not legal pressure upon them for European standardization in order to ensure free and safe movement of goods, personnel and consumers (19). Health ministers agreed in 1998 to collaborate on quality in health care; the Austrian Federal Ministry published a summary of quality policies in EU Member States in 1998 (20), and in accession states in 2001 (21). Successive funded programmes have encouraged collaboration throughout Europe in biomedical and health service research (such as on health care outcomes, hospital utilization (22), and external assessment programmes (23)). The COMAC project (24) compared approaches to quality assurance in 262 hospitals across the EU and has been credited with stimulating formal programmes in Israel (25) and in Poland (26). In May 2000 the Commission adopted a new public health strategy (27) to take account of recent legal and political developments and of the 1998 review of the existing policy in the EC (28). That review had recommended three priorities: · Improving information for the development of public health; · Reacting rapidly to threats t … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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