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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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Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Solidarity is a core social value in

European culture.

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


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Ministry of Health:

Framework for the Health Care System

Self Government:

Joint Federal Committee

Sickness Funds

Hospitals

Practices

Patients

Services.

Prices.

Quality.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Regulation of Quality

Regulation of Care

Regulation of

Quality Management


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Regulation of Quality

Regulation of Care

Structure

Process

Case volume


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Regulation of Quality

Regulation of

Quality Management

Quality Management

National mandatory benchmarking

Public reporting

Sample testing


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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“


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Nat. Institute

Experts

project offices

National Mandatory Benchmarking

1,708 Hospitals in 16 States


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

%

National Benchmarking

Project

Office

Experts


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

%

Struc Dialog

Structured Dialog

Project

Office

Experts

numerical outliers


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

SteeringCommittee

Structured Report

National Committee

and National Experts

Correct!

Check!

Project

Office

Experts

%

qualitative outliers


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Regional Learning.

Project

Office

Experts

regional meetings


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Regulation and Culture


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Patient involvement.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

personal responsibility

and system design


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Quality is team work.

Sharing, networking institutions

instead of castles.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

Pay for Performance?



Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government

You cannot replace primary motivation with financial incentives.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Pay for Performance

Quality of health care

is guaranteed by

primary motivation.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Pay for Performance

There also are

limits to sanctions.



Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

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.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Quality rule: care.

Work with motivation

but without pain no change.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Self Government care.

Quality:

Regulation and Culture


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

Quality care.


Dr christof veit bqs institut for quality and patient safety dusseldorf hamburg

www.bqs.de care.