Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg
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Transcript of Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg
Dr. Christof VeitBQS Institut for Quality and Patient SafetyDusseldorf / Hamburg
Quality and Regulation.Experiences from the German Health Care System.
London, 14th February 2013
Solidarity is a core social value in European culture.
Good quality Health Care for each citizen is a central part of our European societies.
Self Government
Ministry of Health:
Framework for the Health Care System
Self Government:
Joint Federal Committee
Sickness FundsHospitalsPracticesPatients
Services.Prices.Quality.
Self Government
Regulation of Quality
Regulation of Care
Regulation of Quality Management
Self Government
Regulation of Quality
Regulation of Care
StructureProcessCase volume
Self Government
Regulation of Quality
Regulation of Quality Management
Quality Management
National mandatory benchmarking
Public reporting
Sample testing
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
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
Admission Discharge
Indication Process(short term)(long term)
20% 20% 60%
Distribution of quality indicators
Outcome
Hospital Care
National Mandatory Benchmarking
Nat. Institute
Experts
1,708 Hospitals in 16 States
project offices
ProjectOffice
Experts
National Benchmarking
ProjectOffice
Experts
numerical outliers
Structured Dialog
ProjectOffice
Experts
qualitative outliers
Correct!Check!
Steering Committee
National Committeeand National Experts
Structured Report
ProjectOffice
Experts
regional meetings
Regional Learning.
Self Government
Regulation and Culture
Self Government
Patient involvement.
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.
personal responsibility and system design
Quality is team work.
Sharing, networking institutions instead of castles.
Self Government
Pay for Performance?
P4P Modell
Self Government
You cannot replace primary motivation with financial incentives.
Pay for Performance
Quality of health care is guaranteed by primary motivation.
Pay for Performance
There also are limits to sanctions.
Quality and Market.
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.
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.
Quality rule:
Work with motivation
but without pain no change.
Self Government
Quality: Regulation and Culture
Quality
www.bqs.de