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Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg Quality and Regulation. Experiences from the German Health Care System . London, 14th February 2013. Solidarity is a core social value in European culture.

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Presentation Transcript
slide1

Dr. Christof Veit

BQS Institut for Quality and Patient Safety

Dusseldorf / Hamburg

Quality and Regulation.

Experiences from the

German Health Care System.

London, 14th February 2013

slide2

Solidarity is a core social value in

European culture.

Good quality Health Care for each citizen is a central part of our European societies.

slide3

Self Government

Ministry of Health:

Framework for the Health Care System

Self Government:

Joint Federal Committee

Sickness Funds

Hospitals

Practices

Patients

Services.

Prices.

Quality.

slide4

Self Government

Regulation of Quality

Regulation of Care

Regulation of

Quality Management

slide5

Self Government

Regulation of Quality

Regulation of Care

Structure

Process

Case volume

slide6

Self Government

Regulation of Quality

Regulation of

Quality Management

Quality Management

National mandatory benchmarking

Public reporting

Sample testing

slide7

National Mandatory Benchmarking

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“

slide8

Benchmarking: Projects.

>30 Projects on the National Level:

Hip- and Knee Replacement

Cholecystectomy

Gynaecological Operations

Breast Cancer Operations

Obstetrics

Cardiac Pace Makers

Coronary Catheters

Heart Surgery

Decubital Ulcers

Community acquired Pneumonia

Transplants .......and others

distribution of quality indicators
Distribution of quality indicators

Indication

Process

Outcome

(long term)

(short term)

20%

20%

60%

Admission

Discharge

Hospital Care

slide10

Nat. Institute

Experts

project offices

National Mandatory Benchmarking

1,708 Hospitals in 16 States

slide11

%

National Benchmarking

Project

Office

Experts

slide12

%

Struc Dialog

Structured Dialog

Project

Office

Experts

numerical outliers

slide13

SteeringCommittee

Structured Report

National Committee

and National Experts

Correct!

Check!

Project

Office

Experts

%

qualitative outliers

slide14

Regional Learning.

Project

Office

Experts

regional meetings

slide15

Self Government

Regulation and Culture

slide16

Self Government

Patient involvement.

slide17

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.

slide18

personal responsibility

and system design

slide19

Quality is team work.

Sharing, networking institutions

instead of castles.

slide20

Self Government

Pay for Performance?

slide22

Self Government

You cannot replace primary motivation with financial incentives.

slide23

Pay for Performance

Quality of health care

is guaranteed by

primary motivation.

slide24

Pay for Performance

There also are

limits to sanctions.

slide26

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.

slide27

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.

slide28

Quality rule:

Work with motivation

but without pain no change.

slide29

Self Government

Quality:

Regulation and Culture

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