Deepening our Understanding of Quality Improvement in Europe. DUQuE. Deepening our Understanding of Quality Improvement in Europe

Transcription

1 DUQuE Deepening our Understanding of Quality Working Group on Patient Safety and Quality of Care Brussels, 21st of November

2 Project coordination: Avedis Donabedian Institute, Autonomous University of Barcelona. Prof. Rosa Suñol Partners Country coordination Academic Medical Centre, Netherlands Netherlands Institute of Health Services Research, Netherlands Dr Foster Intelligence, UK Department of Clinical Quality and Patient Safety, Central Denmark Region European Society for Quality Management, Poland Institute for Medical Sociology, Health Services Research and Rehabilitation Sciences, Germany European Hospital and Healthcare Federation, Belgium University of California, Los Angeles, USA Avedis Donabedian Institute, Autonomous University of Barcelona, Spain Czech National Accreditation Committee, Czech Republic Dr Foster Intelligence, England Haute Autorité de Sante, France Institute for Medical Sociology, Health Services Research and Rehabilitation Sciences, Germany Polish Society for Quality Promotion in Health Care, Poland General directorate of Health, Portugal Foundation for the Acreditation and the Development of Health Services, Spain Turkish Society for Quality Management, Turkey 2

3 Background Substantial amount of research in the last 30 years on assessing and improving the quality of health care. Considerable progress in developing measurement tools and widespread application; however, quality and safety problems persist. Directive 2011/24/EU of the European Parliament and of The Council of 9 March 2011 on the application of patients rights in cross-border healthcare. Cross border patients should have access to safety and quality information Debate on how to accelerate and sustain quality improvement is more up to date then ever because of the crisis. Relevance for decision-makers at different levels: Hospital, purchasing agencies, EU level

4 Justification Exploration of impact of quality improvement strategies on patient-level quality performance has not been studied at EU level At European level, there is currently no comprehensive guidance for the hospitals on the development of their quality management systems. This research can contribute to this issue DUQUE will aim at identifying the most effective quality and safety mechanisms (perhaps can be used to develop safety and quality standards ) This research would guide purchasers in contracting hospital quality services. 4

5 Overall objective To test whether organisational quality improvement and culture, professionals' involvement, and patient empowerment are associated with the quality of care in European hospitals (as measured in terms of clinical effectiveness, patient safety and patient involvement). 5

6 Main questions to be answered ( Overall objective rephrased) Does (organisational) quality improvement systems at hospital and departmental level relate with quality of care received by patients (measured by clinical effectiveness, patient safety and patient involvement) in 4 conditions: AMI, Stroke, Hip fracture and deliveries? Are hospital management and culture, professionals' involvement, and patient empowerment associated with the quality of care in European hospitals and with the hospital quality improvement systems? 6

7 Key research objectives 1. To develop a maturity classification model for organizational quality improvement systems in EU hospitals (quality management index) 2. To test associations between the quality improvement system and other hospital and departmental level constructs (organizational culture, professional involvement and patient empowerment). 3. To test associations between the maturity classification model and quality at patient level (measured in terms of clinical effectiveness, patient safety and patient involvement). 4. To identify factors influencing the uptake of quality improvement activities by hospitals (external pressure). 7

8 Cross-sectional study Methods Data will be collected at hospital, departmental, professional and patient levels. Measurement of the various constructs will entail both qualitative and quantitative techniques (surveys, chart review, audit, routine data). Triangulation Statistical analyses will include single-level (hospitallevel) and multilevel analyses (for instance, of patient or professional outcomes nested within hospitals). 8

9 Conceptual Model Hospital level Context Variables 1 Patient Empowerment 4 External pressure Hospital governance Quality improvement system 2 Quality Orientation Capital Investment Tasksof theboard Hospital Culture Professional Engagement -Organizational Culture -Social Capital -PatientSafety Culture Care pathway Context Variables Quality Improvement System Patient Saftey Outputs Professionalism: -Professional attitudes -Professional Behavior 3 Patient Empowerment PatientSafety Culture Evidence-based management Patient level Context Variables HIP FRACTURE Clinical Effectiveness STROKE Perceived patient s safety DELIVERIES Patient Involvement ACUTE MYOCARDIAL INFARCTION 9

10 Constructs At Hospital Level At Pathway Level At Patient Level External Pressure External assessment Perceived external pressure Hospital Governance Quality Orientation in Hospital Management Board External Pressure External assessment Perceived external pressure Quality Improvement System Clinical Effectiveness Perceived Patient Safety Quality Improvement System: Patient Safety Procedures Patient Involvement: Quality Management Systems Quality Deployment Hospital Culture Organizational Culture Social Capital Patient Safety Culture Professional Engagement Patient Empowerment Professionalism: Professional Attitudes Professional Behavior Patient Empowerment Patient Safety Culture Patients experience Patients recommendation Health Care transitions Shared decision making Hospital level ContextVariables External pressure 4 Quality orientation in Hospital management Hospital governance board -Organizational Culture -Social Capital 1 Hospital Culture -PatientSafety Quality improvementsystem Culture 2 PatientEmpowerment --QualityManagement systems Professional Engagement -QualityDeployment Evidence-Based Management Patient Information Carepathway ContextVariables Patientlevel Context Variables Professionalism: -Professional attitudes PatientSafety Patient Culture -Professional Behavior Patient Saftey Empowerment procedures Evidence-based management Quality Improvement 3 System Patient sinformation HIP ACUTE STROKE DELIVERIES FRACTURE MYOCARDIAL INFARCTION Clinical Perceived Patient Effectiveness patient s safety Involvement

11 Expected output Development of guidance for hospitals an in-depth overview on the effectiveness of quality and safety strategies and how to integrate them at hospital and departmental level. Appraisal scheme for purchasers identifying the core quality and safety strategies that should be in place in European hospitals. 11

12 Countries participating in the field test

13 Countries and Hospitals participation. Design 2009 Total hospitals (n=240) and patients (n=11520) Countries Chech Republic England France Germany Poland Portugal Spain Turkey Participation and Activities at country level 30 hospitals Activities: - Surveys to professionals - Routine Data Collection 12 hospitals (from the previous 30) Additionally will perform the following Activities: - Chart review > Patients surveys > Surveys to professionals > Hospital visits = 80 13

14 Study to be carried out by all 30 hospitals Q U E S S T I O N N A R I E S CONSTRUCTS TO BE MEASURED 1. Hospital Governance and Organizational Culture 2. Hospital Governance and Organizational Culture 3. Hospital Governance and Organizational Culture 4. Quality Improvement Systems 5. Patient Safety Culture and Empowerment Who answers the questionnaire? Number of surveys? Number of items and estimated time for completion Chair Board of Trusties 1 15 minutes 28 items CEO 1 30 minutes 52 items CMO and HLN 1 each 10 minutes 20 items QM 1 15 minutes 20 items Clinical leaders (Doctors and Nurses) 6. Administrative data Hospital Minium Data-Set 1 file minutes 34 items Administration System PAPER/IT PLATFORM PAPER/IT PLATFORM PAPER/IT PLATFORM IT PLATFORM IT PLATFORM

15 12 hospitals for the in-depth study: Questionnaires to professionals CONSTRUCTS TO BE MEASURED Who answers the questionnaire? Number of surveys? Number of items and estimated time for completion Administration System Q U E S T I O N N A I R E S 7. Quality Improvement Activites, patient safety and Pathway design for each condition 8. Professional involvement, Patient Safety Culture and Patient Involvement Head of Department Professionals involved in the care of patients within each condition pathway 1 per pathway 20 per pathway 15 minutes 16 items 15 minutes 60 items PAPER/ IT PLATAFORM IT PLATAFORM

16 12 hospitals for the in-depth study: Patients Questionnaires and Charts review CONSTRUCTS TO BE MEASURED 9. Patient Involvement and experience Type of assessment and number needed 30 Patients questionnaires per condition Number of questions/in dicators of each instrument Administration System Estimated time for completion 23 questions PAPER 6 minutes 10.Clinical effectiveness and patient safety 35 Chart review of indicators per condition 6-7 indicators per condition PAPER minutesper case EXTERNAL VISIST(personnel from outside de hospital) Constructs to be measured Answers obtainedfrom: Administration System Clinical Effectiveness and Patient Safety Assessment will be performed by external professionals IT PLATFORM Estimated time for compeletion 1 person /2days

17 Results achieved so far 11 questionnaires with 30 constructs (most already existing measures) available in 8 languages (double translation) in phase of validation. Already in public domain for researchers A network of more than 200 hospitals in 8 countries involved using same measures (and an excellent group of country organizations coordinating!) More than 60% of data collected so far An ambitious analysis plan offering possibilities to secondary analysis to other researchers An important advisory group including all stakeholders

18 Other important achievements Coordination with QUASER: Same objective, different methods Dissemination Portugal, Poland, France, Spain. Scheduled presentations: Working Group on Patient Safety and Quality of Care (EU), European Forum for Quality (seminar, April 2012), ISQuA (in process) Articles published (1 BMC Health Services Research) Policy Summary Leaflets Web

19 Thank you!!

20 This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.