QUALITY MANAGEMENT BRIGITTE DOMITTNER GESUNDHEIT STERREICH GMBH Topic

QUALITY MANAGEMENT BRIGITTE DOMITTNER GESUNDHEIT ÖSTERREICH GMBH

Topic Points ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Importance of Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

Gesundheit Österreich Gmb. H, Vienna

Organisation Status Ø Limited company owned by the Federal State of Austria Ø State is represented by the Austrian Ministry of Health Ø Non profit organisation Ø Independent in our scientific work Ø Legal Basis • Federal Law for establishing “Gesundheit Österreich Gmb. H” • Federal Law on Quality for Health Services for establishing BIQG • Health Promotion Law for establishing Fund for a Healthy Austria (FGÖ)

Main tasks Ø “Think-Tank” for the Austrian Health Care System. Ø Supporting Ministry of Health, provinces and other stakeholders in preparing policy briefs, statutory regulations, etc. Ø Scientific research and analysis Ø Provision of information for nationwide planning, regulation, governance and (economic) evaluation in health care Ø Health Promotion and Preventive Health Ø Development, implementation and evaluation of a nationwide quality system. Ø Participation in national and international projects and working groups

Topic Points ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Importance of Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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 1 www. 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 Ø Finding mistakes/errors Ø External assessment/control Ø Culture of mistrust Inspecting the past

Evolution of Quality II Ø avoid mistakes Ø personal responsibility / ownership Ø culture of trust Looking into the past and plan for the future

Evolution of Quality III Systematic fulfillment of customer requirements

Evolution of Quality IV Participation of all members of an organization

Topic Points ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Importance of Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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

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

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

Topic Points ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Importance of Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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

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 Review 3. External audit by an external certification 4. Issue of certificate valid for 3 years 5. Surveillance Audits internal auditing by trained internal staff every year 6. 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

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

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 Detailed information in a separate presentation! Source: http: //www. efqm. org

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

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

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 in more than 90 countries Source: www. jointcommissioninternational. org www. jointcommission. org

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

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

(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 ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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 Kai 善 Zen

PDCA-Cycle (W. Edward Deming) y t t i l a n u e Q em g a n m a e t M Sys y t i l a u Q t s u n o e u m n i e t v n o C Impro

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 ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: Platform The Quality www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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 panels Goal: 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 ü Introduction Gesundheit Österreich Gmb. H ü Definition and evolution of Quality ü Total Quality Management ü Quality Management Systems used in health care organizations ü Continuous Quality Improvement ü Regular reporting on the quality systems in Austria’s hospitals and rehabilitation centres: The Quality Platform www. qualitaetsplattform. at ü Detailed Information about the questionnaire for quality reporting

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/Standards o Admission/Discharge procedures o Operative management o 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 promotion § Suggestions and complaints (survey method, handling, analysing, employee suggestion system) o External quality-projects o Patient Safety and Risk Management (instruments, reporting systems organisation, staffing, qualification) o Continuous Quality Improvement o

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 0 5 ISO implementiert 25 30 35 40 20 3 38 5 EFQM geplant CAF implementiert 0 0 CAF geplant 0 11 1 0 13 1 KTQ geplant 0 10 1 2 JCI geplant 4 Sonstige implementiert (Summe)* Sonstige geplant (Summe)* 20 11 0 45 41 4 EFQM implementiert JCI implementiert 15 5 ISO geplant KTQ implementiert 10 26 6 für Teile der Organisation für die gesamte Organisation

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!