Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg Quality and Regulation. Experiences from the German Health Care System. London, 14 th 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 Funds Hospitals Practices Patients Services. Prices. Quality.
Self Government Regulation of Quality Regulation of Care Regulation of Quality Management
Self Government Regulation of Quality Regulation of Care Structure Process Case volume
Self Government Regulation of Quality Management National mandatory benchmarking Public reporting Sample testing
National Mandatory Benchmarking Measurement areas: 30 Quality indicators: 289 (88% risk adjusted) Data sets: 3. 600 Million Hospitals: 1, 605 Data validity: good (different validation procedures) Results: ranging from „requires national level intervention“ to „excellent“ 96. 6% 98. 2%
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 Indication Process 20% Admission Outcome (short term) (long term) 60% Discharge Hospital Care
National Mandatory Benchmarking Nat. Institute Experts 1, 708 Hospitals in 16 States project offices
National Benchmarking Project Office Experts
Structured Dialog Project Office Experts numerical outliers
Steering Committee Structured Report Project Office National Committee and National Experts Correct! Check! qualitative outliers
Regional Learning. Project Office Experts regional meetings
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?
P 4 P 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 equality 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
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