Adapting the ISO series - experiences with quality management in Jellinek Centre, The Netherlands

1. Adapting the ISO series - experiences with quality management in Jellinek Centre, The Netherlands Ineke Kosse, Jellinek Centre, Amsterdam “Quality Management in the Public Sector”Vilnius 27-28 March 2006

3. Agenda 1. What is Jellinek? 2. Quality projects in Jellinek 3. HKZ / ISO approach 4. Benefits of a quality management system 5. Where is the end?

4. 1. What is Jellinek?

5. Addiction Centre Mission: • The Jellinek Center is a dedicated, innovative and leading organization for prevention, cure and care of persons with addiction problems and related high-risk life-styles. History: • Founded 1909 for alcohol problems, since 1970 also dealing with drugs, since 1990 dealing with various addictions Resources: • 600 personnel, budgets 30 million Euro a year, 7 locations Organization: • Non-profit foundation with 3 divisions Patients: • Annual caseload - 3500 in the region of Amsterdam

6. Organisation structure

7. Disease management in addiction care[Skinner, 1988] No use of substance experimental use of substance Use of substance without complaints Riskfull use of substance Risk full use of substance with complaints Addicted Chronically addicted

8. Alcohol problems

9. Drug problems

10. Smoking problems

11. Gambling problems

12. Eating problems

13. Alcohol Heroin Cocaine Cannabis Smoking Medicine Gambling Other Annual statistics Substances 44% 2389 21% 18% 1365 5% 512 1% 88 1% 92 5% 559 5% 1955 13 094 treatment episodes 4 164 clients - 76% male, 24% female, 30% employed, 73% Dutch DSM IV 59% Axis I problems, 25% Axis II problems

14. Treatment overview internet Prevention Selfhelp shortintervention interventionswithout lodging/stay detox Evaluation intake / referral After care interventions withday (night) lodging/stay interventions with 24-hourslodging/stay Proactive case management and time out

15. Treatment services • Prevention • Campaigns, training, counselling, advice, epidemiology survey, unity peer project • Intake • Standard assessment, planning and coordination, probation, follow-up • Intensive Cure • Outpatient detox, motivational interviewing, relapse prevention, life style training, counselling for doctors • Intensive Care • Crisis intervention, in-patient detox, double diagnoses, methadon programmes, culture-specific care, sheltered housing, day support, work programs, case management, counselling for social services • Dentistry and Clinical Lab

16. Question: Who are your clients?

17. Accountants Lawers Consultancy Partners Stakeholders Government Local politiciens Media Financing organisations GG&GD Schools Management Housing companies Police External customers Hospitals Doctors Employees Internal Clients Employment services Social Network Cleaning companies Clients Supply chain Travel agency Pharmacy Food suppliers Linen suppliers Neighbourhood Suppliers Citizens Actors

18. Quality projects in Jellinek

19. Quality projects in Jellinek START

20. Leidschendam 3 Resultaten Scoren Leidschendam 1 Leidschendam 2 & Kwaliteitswet Quality projects in Jellinek Ups and downs in Quality Management Performance Management Department Q&I HKZ certification EFQM Assessment (new) ISO Certificate ISO Certificate EFQM Ass. Best in Class Dutch INK Quality Prize EFQM/INK Assessment ECD Kick- off Beach Hotel EFQM/INK Model Relocate Improvement Projects Quality manager Implementation Problems BPR Relocate BPR Energy Problems ISO Project Adaptation Problems Change Organisation Structure Resistance Action Plan Indicator System The Zoo Getting Lost 2004 2005 2006 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

21. Quality projects in Jellinek Improvement projects • Shadowing • Project “Letters” • Jellinek News • Informatics • Relapse prevention • Pharmacotherapy • Part-time treatment

22. Processes 20% 40% 60% 80% Resources Leadership V IV III Personnel management Policy and strategy II I Personnel satisfaction Customer satisfaction Impact on society 1996 1994 Quality projects in Jellinek EFQM1994and 1996 ORGANISATIE-GEORIENTEERDE AANDACHTSGEBIEDEN FASEI FASEII FASE III FASE IV FASEV AANDACHTS-GEBIEDEN DEELASPECTEN 1A Betrokkenheid leiding (53%) [60%] 1.LEIDERSCHAP(49%) [60%] 1B Kwaliteitscultuur (58%) [70%] 1C Erkenning, waardering (45%) [50%] 1D Ondersteuning (40%) [60%] 2A Kwaliteitsmanagement (65%) [70%] 2.BELEID ENSTRATEGIE(57%) [62%] 2B Informatie (65%) [80%] 2C Bedrijfsplannen (55%) [60%] 2D Communicatie (60%) [50%] 2E Toetsing (40%) [50%] 20% 40% 60% 80% 3A Personeelsbeleid (35%) [50%] 3.PERSONEELSMANAGEMENT(34%) [55%] 3B Deskundigheid (25%) [50%] 3C Totstandkoming van doelen (58%) [60%] 3D Betrokkenheid bij verbet. (20%) [60%] 4A Financiën (43%) [60%] 4.MIDDELENMANAGEMENT(44%) [45%] 4B Informatievoorziening (65%) [50%] 4C Leveranciers (25%) [40%] 4D Technologie (45%) [30%] 5A Identificatie van processen (38%) [50%] 5B Besturing, beheersing (30%) [50%] 5.MANAGEMENTPROCESSEN(25%) [50%] Results 5C Doorlichting, verbetering (20%) [50%] 5D Stimuleren van innovatie (23%) [50%] 5E Procesverandering (15%) [50%]

23. Quality projects in Jellinek Improving Processes • Long preparation • Flowcharts for teams • Handbook for teams • New project leader • Certification audit • Internal audits • In January 1999 the Minister of Health handed over the ISO certificate to the Jellinek

24. Quality projects in Jellinek absence through sickness

25. And running further…

26. HKZ model Explanation of the HKZ model

27. HKZ modelDeveloped by: Health care organisations Patients Health insurance companies

28. HKZ model Containing quality aspects from: • The National organisation for mental health (GGZ) • Professionals working in the mental health sector • Health insurance companies • Patient organisations • Legislative and regulatoryrequirements

29. HKZ model Benefits in comparison with ISO 9000: • Primary process is central • Requirements are integrated in the primary process • Harmonisation in the mental health care supply chain • Educate knowledge professionals • Containing specific legislative and regulatory for themental health care

30. HKZ Model 4 policy & organisation 9 documents 5 Personnel 3 Evaluation 1 Intake 2 Treatment 8 services by third parties 6 R & D 7 Environment

31. HKZ ModelExample intake process

32. HKZ Model Question about complaints

33. HKZ ModelHKZ requirements aboutComplaints 1.19 Patients are given the complaints procedure 1.4.6 Organisational capacity to handle complaints 3.5 Handle complaint according to procedures 4. Agreement with patients organisations about complaints procedure 4.20 Complaints Commission 5.5 Complaints from personnel

34. Benefits of HKZ What are the benefits of having a certified quality system?

35. Benefits of HKZ • Processes are clear • Responsibilities • Transparency • To demonstrate quality to second parties

36. But is certification the end …?

38. … or the starting point to becoming the best?

39. Conclusion • 15 years of practice in Quality Management shows ups and downs … but a positive trend • Consistency in leadership, e.g. quality budget in 2003 >2% • Integral Quality Policy is needed, not just one strategy (EFQM assessment combined with ISO process management, evidence based treatment and learning based on outcomes) • Self assessment (Plan-Do-Check-Act) was/is an important tool for (creating) an organization culture where quality improvement is embedded in professional-based practice.

40. Future • Maintain Integral Quality Policy • Further improvements in performance management • Further use of Technologies • Further use of the following ‘rich resources’ [Berwick, 2002] • Clients, families and communities • The life experience of the health care workforce • Knowledge from the variation among us • Global brains

41. Ačiū Thank you ikosse@jellinek.nl