dr. christof veit bqs institut for quality and patient safety dusseldorf / hamburg quality and...
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Dr. Christof VeitBQS Institut for Quality and Patient SafetyDusseldorf / Hamburg
Quality and Regulation.Experiences from the German Health Care System.
London, 14th February 2013
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Solidarity is a core social value in European culture.
Good quality Health Care for each citizen is a central part of our European societies.
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Self Government
Ministry of Health:
Framework for the Health Care System
Self Government:
Joint Federal Committee
Sickness FundsHospitalsPracticesPatients
Services.Prices.Quality.
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Self Government
Regulation of Quality
Regulation of Care
Regulation of Quality Management
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Self Government
Regulation of Quality
Regulation of Care
StructureProcessCase volume
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Self Government
Regulation of Quality
Regulation of Quality Management
Quality Management
National mandatory benchmarking
Public reporting
Sample testing
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Measurement areas: 30
Quality indicators: 289 (88% risk adjusted)
Data sets: 3.600 Million 96.6%
Hospitals: 1,605 98.2%
Data validity: good (different validation procedures)
Results: ranging from „requires national level intervention“ to „excellent“
National Mandatory Benchmarking
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Benchmarking: Projects.
>30 Projects on the National Level:
Hip- and Knee ReplacementCholecystectomy Gynaecological OperationsBreast Cancer OperationsObstetricsCardiac Pace MakersCoronary CathetersHeart SurgeryDecubital UlcersCommunity acquired PneumoniaTransplants .......and others
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Admission Discharge
Indication Process(short term)(long term)
20% 20% 60%
Distribution of quality indicators
Outcome
Hospital Care
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National Mandatory Benchmarking
Nat. Institute
Experts
1,708 Hospitals in 16 States
project offices
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ProjectOffice
Experts
National Benchmarking
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ProjectOffice
Experts
numerical outliers
Structured Dialog
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ProjectOffice
Experts
qualitative outliers
Correct!Check!
Steering Committee
National Committeeand National Experts
Structured Report
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ProjectOffice
Experts
regional meetings
Regional Learning.
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Self Government
Regulation and Culture
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Self Government
Patient involvement.
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Quality Improvement starts with a narcistic wound:I am not as brilliant as I would love to believe.
And besides of 1000 excuses: I could have done better.
I do better.
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personal responsibility and system design
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Quality is team work.
Sharing, networking institutions instead of castles.
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Self Government
Pay for Performance?
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P4P Modell
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Self Government
You cannot replace primary motivation with financial incentives.
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Pay for Performance
Quality of health care is guaranteed by primary motivation.
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Pay for Performance
There also are limits to sanctions.
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Quality and Market.
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Market lives from differences.
Trust comes from equal quality of care at all places.
Quality improvement is about lowering variation towards better care.
Good quality care + Patient’s choice.
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But: market mechanisms also want to differentiate access to care.
Prime offers for a smaller number of wealthy patients.
Solidarity?
We call it: the freedom of the free fox in the free hen house.
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Quality rule:
Work with motivation
but without pain no change.
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Self Government
Quality: Regulation and Culture
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Quality
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www.bqs.de