UvA-DARE (Digital Academic Repository) Divergent sight: studies on the application of industrial quality and safety improvement methods in eye hospitals de Korne, D.F. Link to publication Citation for published version (APA): de Korne, D. F. (2011). Divergent sight: studies on the application of industrial quality and safety improvement methods in eye hospitals. Amsterdam: Dirk F. de Korne. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (http://dare.uva.nl) Download date: 05 Apr 2019
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1 make an appointment 2 desk 3 outpatient visit 4 additional examinations? yes yes 5 make an appointment no 6 diagn. exam. perimetry no 7 outpatient visit no 8 change of treatment? 57 end no 56 next visit? 9 choose treatment 10 medicat ion 12 laser no 12 surgery 11 prescription 13 make an appointment 32 intake 14 laser 33 pre-examination 15 pressure exam. perimetry 34 choose inpatient 27 eye pressure yes perimetry 26 pressure exam. after 3 days no 16 pressure peak? yes 35 daycare 28 visit opthalmologist 17 call opthalmologist 36 admission 45 clinical admission eye inflammation 30 add. yes medication 18 add. medication? 37 surgery 46 admission yes no 19 prescription 38 discharge 47 surgery 20 add. pressure exam.? 39 post surgical visit after 1 day 48 post surgical control after 1 day yes 49 surgery successful? no 51 discharge yes 21 pressure exam. 40 surgery successful? yes 50 discharge 52 make an appointment no 22 same day 24 after 3 days 41 make an appointment 53 re-admission 23 pressure exam. 25 pressure exam. 42 re-admission 54 re-surgery 43 re-surgery 44 post surgery control 55 post surgery visit 82
External reimbursement Functional based budget system Fixed diagnosis treatment combination (DBC) Free price Organisational structure Treatment teams (with hierarchical responsibility for heads of functional departments) Head per team Clinical pathways Shared care Cooperation optometrists primary care Transmural optometrist care Glaucoma Shared Care Unit Shared OPD Innovation / Technology Use of GDx Increasing medication Demand Increasing number of patients, burden on outpatient department [patient stop] Increasing number of patients, decreasing burden for outpatient department Increasing patientnumbers QCM 1 (cataract) QCM 2 (glaucoma) Use of quality indicators QCM3 (glaucoma) 2002 2003 2004 2005 2006 2001 2007 t=0 t=1 t=2 83
1000 900 800 700 600 500 400 300 200 100 0 2001 2002 2003 2004 2005 2006 12.000 10.000 8.000 6.000 number of treatments number of outpatient visits 4.000 2.000 0 Trabeculectomy YAG/LTP laser Baerveldt implants 1st visit Outpatient Department (OPD) OPD glaucoma 1st visit Glaucoma Shared Care Unit Glaucoma Shared Care Unit (total) 84
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Care process (A) Outcome indicators (B) Process indicators (B) Costs of noncompliance (C) Compare to standards (D) Confirmation to standards OK No confirmation to standards Analyse the problem (E) - understand variation - valuing variation - identify causes - valuing causes Develop solutions and determine cost ot these (F) Cost benefit analysis (G) Implement (I) Select a solution (H) 87
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