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Département fédéral de l'intérieur DFIOffice fédéral de la santé publique OFSPDivision Programmes nationaux de prévention

Incentives to implement the QuaTheDA Reference SystemRené Stamm, Federal Office of Public Health, SwitzerlandEQUS Conference Brussel, June 16th 2011

Incentives to implement the QuaTheDA Reference System

a quality norm for drug treatment services

René Stamm, Federal Office of Public Health, Switzerland

EQUS Conference

Translating Standards into Practice

June 16th, 2011

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Presentation

1. The quality approach according to QuaTheDA

2. Setting of the project and general strategy

3. Five examples of incentives- Training activities - Quality instruments- Participative process- Certification- Promotion of QuaTheDA

4. Conclusion

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The quality approach according to QuaTheDA

The Reference System QuaTheDA (Quality Therapy Drug Alcohol)

is a quality norm recognised by the Swiss Accreditation Service

is used for a certification process by external audits

was specifically developed for institutions in this field, on the general model of the ISO-Norm

is based on evidence based quality standards

was elaborated in collaboration with professionals

is targeted at structure and process quality of institutions

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Definition: list of all structure and process related quality requirements which have to be fulfilled to become QuaTheDA certified

Can also be used as a self evaluation tool

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Requirements are divided into two parts:

1. Requirements concerning management and support processes of any kind of addiction treatment services

2. Requirements concerning the treatment processes for 8 specific types of services: - in-patient therapy - out-patient therapy - out-patient therapy with substitution programmes - harm reduction services - etc

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The quality approach according to QuaTheDA addressed topics for requirements of management:

Management processes

Support processes

Supplies processes for 8 specific types of services

1. Management and therapy concepts 2. Directorate and organisation 3. External communication and cooperation4. Quality management and controlling5. Mission statement and strategy development

1. Manpower / staff2. Finances 3. Hygiene, housekeeping, waste management and security4. Patient security5. Legal prescriptions and guide lines

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The quality approach according to QuaTheDA addressed topics for requirements of treatment processes:

Management processes

Support processes

Supplies processes for 8 specific types of services

1. Assessment and admission

2. Therapy and rehabilitation3. Leaving and closure4. Networking5. Reporting

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The quality approach according to QuaTheDA2 examples of requirements:

B/5: External communication and cooperation - Partners with strategic signification - Form of communication with them - Written cooperation convention - etc.

B/8: Manpower - Special qualification of the staff - Ongoing education - Regular support activities for the staff - Health and security measures for the staff - etc.

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Setting of the project and general strategy

In Switzerland, most of the competences on health issues lie with cantons

The drug policy in the 90s put the Federal Office of Public Health (FOPH) in a leading position. It gave us the legitimacy to become active in this new field

Another Federal Office created the opportunity to act:it decided in 1998 that in-patient therapeutical institutions had to fulfil quality standards in order to get their fundings

Facing a completely new situation, institutions were prepared to accept support

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Window of opportunity to set up a quality project based on following considerations:

If each institution would choose its own quality model, dialogue and comparability between institutions would become very difficult

Even more important than the quality model was starting a process of continuous improvement

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Strategical consequence:

To establish a quality norm and quality management system valid for the whole addiction field, so that professionals apply a similar model and think in the same logic

As having no legal authority to impose as such, necessity to find incentives to convince the institutions and the Cantons to adopt this quality model

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Objective of FOPH:

To involve the whole addiction field in a quality improvement process starting with the in-patient treatment institutions that are under external pressure to act.

Once this professional sector is covered, go forward with out-patient treatment services (therapy and harm reduction)

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1st incentive: training activities

2000: FOPH organized a free training program for all the in-patient treatment institutions which would implement QuaTheDA

FOPH published a manual as implementing support

Advantage for the institutions:- they are being assisted in facing a big challenge: a new activity based on an approach, which is not familiar to their way of thinking - they do not have to pay for a quality consultant- they get in contact with other institutions and can exchange best practice

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1st incentive: training activities

2006: Organizing for out-patient treatment institutions a new training program for the implementation of the new QuaTheDA Modular Reference System

Publication of a new manual giving explanations to the requirements

Organizing yearly continuing education activities to current issues as e.g. how to elaborate a new strategy for the institutions, how to plan and conduct an internal audit, etc.

These training activities are not free anymore

Organizing every two years a national symposium dedicated to current issues

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2nd incentive: quality instruments

Four different questionnaires for measuring the satisfaction of patients:- QuaTheSI I 40 for in-patient institutions- QuaTheSI II 17 for out-patient institutions- QuaTheSI III 18 for out-patient institutions with substitution- QuaTheSI VII 19 for institution providing harm reduction facilities

An evaluation is done once a year on national level by an external institute

Each institution gets its own data and can compare them with others.By analysing its results it can elaborate measures to improve the quality of their facilities

To motivate the institutions to participate, the first 3 years are free

One questionnaire for measuring the satisfaction of staff

Next step is to make available instruments to measure outcomes

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3rd incentive: a participative process

The 2 Reference Systems were elaborated with the main stakeholders: the professionals and the Cantons

The QuaTheDA Modular Reference System is currently being reviewed together with stakeholders

Through that participative process, the FOPH wanted to create the feeling - that QuaTheDA is adapted to their needs. It is made for them.- that it reflects a general standard of quality accepted by all stakeholders- of belonging to the community (of the « outstanding and recognized institutions ») of the addiction field

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4th incentives: a certification system

To be QuaTheDA-certified, the institutions have to pass an external audit with officially accredited certification centers

Advantages of a certification :

- institutions get a recognition of their general quality level which is recognised by the sponsors- the certification has the same value as an ISO-certification- through the external audit, the institutions receive the external view of a neutral person able to point out weaknesses of the institution- the date of the external audit gives a concrete goal to reach for the project of implementing a QMS. You avoid the risk of a never ending project.

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5th incentive: promotion of QuaTheDA at the sponsors

Regular information of cantons and cities about the different aspects of the project

To give them the opportunity to review the requirements of the QuaTheDA Reference System and make their proposals

To convince cantons and cities to include in service agreements with the institutions the obligation of being certified according to QuaTheDA

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Incentives: results

57 in-patient treatment institutions are certified according to QuaTheDA (about ¾ of this type of institutions) and more than 100 out-patient treatment services (including services providing harm reduction facilities)

2/3 of the Cantons recommend QuaTheDA

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Conclusion

The FOPH followed a double incentive strategy that could be called « The carrot and the stick ». The 3 first ones are « carrots» and the 2 last ones are « sticks »

Based on the belief that both of them are equally important Using only « carrot like » incentives is idealistic Using only « stick like » incentives creates resistance

The long-term vision of the QuaTheDA project is to enable all stakeholders to move upwards in an improvement process of the quality of their facilities

This has to be made step by step. The next one is dedicated to outcome quality.

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