Quality Management

Brigitte Domittner
Gesundheit Österreich GmbH
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management
 Quality Management Systems used in health care
organizations
 Importance of Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management
 Quality Management Systems used in health care
organizations
 Importance of Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Gesundheit Österreich GmbH, Vienna
Organisation Status

 Limited company owned by the Federal State of Austria

 State is represented by the Austrian Ministry of Health
 Non profit organisation
 Independent in our scientific work
 Legal Basis
• Federal Law for establishing “Gesundheit Österreich GmbH”
• Federal Law on Quality for Health Services for establishing BIQG
• Health Promotion Law for establishing Fund for a Healthy
Austria (FGÖ)
Main tasks

 “Think-Tank” for the Austrian Health Care System.

 Supporting Ministry of Health, provinces and other
stakeholders in preparing policy briefs, statutory
regulations, etc.
 Scientific research and analysis
 Provision of information for nationwide planning,
regulation, governance and (economic) evaluation in health
care
 Health Promotion and Preventive Health
 Development, implementation and evaluation of a
nationwide quality system.
 Participation in national and international projects and
working groups
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality

 Total Quality Management
 Quality Management Systems used in health care
organizations
 Importance of Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Definition of quality

Origin: Latin quālitās “of what sort”1

= “the standard of something as measured against other things of

a similar kind; the degree of excellence of something” 1

Informal: quality = good quality

Individual judgment of quality depends on various aspects, e.g.

experience, education, environment

1 www.oxforddictionaries.com
Quality specifies …

... the extent to which a product (good or

service) meets the existing requirements/
standards.
In a nutshell: Evidence of good quality is...

... when the

customer
returns and
not the product!
Evolution of Quality
Evolution of Quality I

 Finding mistakes/errors

 External assessment/control  Inspecting

 Culture of mistrust
the past
Evolution of Quality II

 avoid mistakes
 Looking into
 personal responsibility /
ownership the past and
plan for the future
 culture of trust
Evolution of Quality III

 Systematic fulfillment of
customer requirements
Evolution of Quality IV

 Participation of all members of

an organization
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality

 Total Quality Management

 Quality Management Systems used in health care
organizations
 Importance of Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Total Quality Management

» Organization wide management philosophy for

continuously improving the quality of products /
services and its processes

» Continuously quality improvement is the

responsibility of everyone who is involved in the
production or use of the products or services
offered and hence is interested in its quality

Source: Øvretveit, (2000): Total quality management in European healthcare

Who is interested in quality?

Customer satisfactory quality of received

product / service

Employees workplace satisfaction, career

opportunities ...

Owner maximum created value

Supplier long-lasting  business relationship

Society responsible and sustainable behaviour

Total Quality Management

» Organization wide management philosophy for continuously

improving the quality of products and processes
Main components:
» Focusing on consumer (and suppliers)
» Analysing processes
» Working in quality project teams
» Systematically analysing quality problems, planning change
und evaluating the results
» Using data to identify and analysing problems and evaluating
the results
» Implementing change

Source: Øvretveit, (2000): Total quality management in European healthcare

Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management

 Quality Management Systems used in

health care organizations
 Importance of Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Quality Management Systems used in health care
organizations

Selected Systems:

» International Organization for Standardization – ISO

» European Foundation for Quality Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und Quality in Healthcare -

KTQ
Quality Management Systems used in health care
organizations

Selected Systems:

» International Organization for Standardization –

ISO

» European Foundation for Quality Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und Quality in Healthcare - KTQ

International Organization for Standardization (ISO)

» 1946: Meeting of delegates from 25 countries at the Institute

of Civil Engineers in London

subject: ‘to facilitate the international coordination and

unification of industrial standards’

» 1947: Creating the International Organization for

Standardization

» 2012: ISO is a network of national standards institutes from

163 countries

» 2012: Over 19 000  International Standards covering almost

every aspects of technology and manufacturing

Source: www.iso.org
ISO 9000 ff Quality Management
» Originally developed for the industry
» Increasing use of standards in other areas (e.g. healthcare)
» 2000: General revision and simplification of the ISO 9000
series (=Quality Management)

There are many standards in the ISO 9000 family, e.g:

» ISO 9000:2005 - covers the basic concepts and language
» ISO 9001:2008 - sets out the requirements of a quality
management system = base for certification
» ISO 9004:2009 - focuses on how to make a
quality management system more efficient and effective
» Current: Review of a European Standard for health care
services – requierements based on EN ISO 9001:2008

Source: www.iso.org
ISO Model of a process-based quality management
system

Source: www.iso.org
ISO Quality Management Principles

Source: www.iso.org
ISO - Certification

» ISO develops International Standards and does not itself

certify organizations
» External certification bodies perform the certification

Procedure:
1. Preliminary Audit (optional)
2. Documentation Review
3. External audit by an external certification
4. Issue of certificate  valid for 3 years
5. Surveillance Audits  internal auditing by trained internal
staff  every year
6. Certification Renewal

Source: www.iso.org
Certification versus Accreditation

Certification
» written assurance (the certificate) by an independent external
body that processes or products conform to the requirements
specified in the standard

Accreditation
» Is a formal recognition by an accreditation body that a person
or institution is competent to carry out the certification in
specified business sectors (= certification of the certification
body)

» Terms accreditation and certification are often used

incorrectly synonyms
Source: www.iso.org
Quality Management Systems used in health care
organizations

Selected Systems:

» International Organization for Standardization – ISO

» European Foundation for Quality

Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und Quality in Healthcare -

KTQ
 European Foundation for Quality Management – EFQM

» Founded in 1989 by 14 European organisations, in order to

increase the competitiveness of European organisations
» Not-for-profit membership foundation based in Brussels
» Creater of „The EFQM Excellence Model“
» The aim of the Model is to improve performance in order to
reach „Excellence“
» 2012: more than 30 000 organisations in Europe use the Model
» Provide training, assessment tools and recognition for high
performing organisations  EFQM Excellence Award

Source: http://www.efqm.org
European Foundation for Quality Management – EFQM

Detailed information in a separate presentation!

Source: http://www.efqm.org
Quality Management Systems used in health care
organizations

Selected Systems:

» International Organization for Standardization – ISO

» European Foundation for Quality Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und Quality in Healthcare - KTQ

Joint Commission International - JCI

Joint Commission on Accreditation of Healthcare Organizations -

JCAHO
»Founded in 1951
»Independent, not-for-profit organization
»Define quality standards specially tailored for health care facilities
»focuses on safety quality of medical services, patient and
employee satisfaction
»All processes are assessed (from patient registration, examination,
treatment up to the transfer and discharge of a patient)
»Accredits and certifies more than 19,000 health care
organizations and programs in the United States
»The whole organization, not just individual departments are being
evaluated

Source: www.jointcommissioninternational.org
www.jointcommission.org
Joint Commission International - JCI

Joint Commission International – JCI

» Created in 1994
» Implements the goals of the JCAHO at an international level
» Supports health care organizations through accreditation,
education and technical assistance
» Accreditation of an organization: Is a recognition given to the
healthcare organization, which meet the
JCI standards
» JCI has a presence in organizations in
more than 90 countries

Source: www.jointcommissioninternational.org
www.jointcommission.org
Quality Management Systems used in health care
organizations

Selected Systems:

» International Organization for Standardization – ISO

» European Foundation for Quality Management – EFQM

» Joint Commission International – JCI

» The Cooperation for Transparency und

Quality in Healthcare - KTQ
The Cooperation for Transparency und Quality in
Healthcare - KTQ
» initiated in 1997 by the German federal chamber of physicians (BAeK)
and the federal associations of various health insurance funds. Later
joined by the hospital federation and the nursing council
» Is an organization which offers quality management certification for
health care organizations
» Mission is to strengthen transparency in the performance of hospitals
through providing comprehensible information to all concerned,
including patients (quality report)
» KTQ analyzes and reviews medical, nursing and administrative
processes
»  Certifies health care organizations

Source: www.ktq.de
The Cooperation for Transparency und Quality in
Healthcare - KTQ
» 1. Self-assessment
Self-assessment of the organization based on the KTQ
catalog .
 Describes the present situation, identifies room for
improvement and establishes inter-departmental
communication structures
» 2. External assessment (site visits)
External assessments on site though qualified KTQ visitors
» 3. Quality report and issue of certificate
Score higher than 55% in external assessment
 issue of a KTQ certificate (valid 3 years)

Source: www.ktq.de
(Certified) QMS - what could be the benefits?

e.g.:

» Optimized work processes

» overall quality improvement

» Marketing Tool

» Feedback from experienced external auditors/visitators

» Increased patient safety

» Increased patient satisfaction

» Optimized existing resources

» ...
(Certified) QMS - what could be the disadvantage?

e.g.:
» Higher costs to health care
» Added bureaucracy
» Time consuming
» Not being very practical for the organizations (ISO)
» Focusing primarily on processes and structure, less on
outcome
» Implementation of standards are too lenient
» Process does not end with the final implementation and
certification  system needs maintaining without an final end
» …
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management
 Quality Management Systems used in health care
organizations

 Continuous Quality Improvement

 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
Continuous Quality Improvement
» Based on the Japanese philosophy of “Kaizen”

» Kaizen means “good change" ,

„change for the better“

» Never-ending efforts for improvement

改
Kai
(continuous learning from mistakes,
organisational learning)

» Involving everyone in the organization (all

hierarchy level, from the CEO to the lowest
level workers)
善
Zen
» Process oriented rather than outcome

 From small steps to big results

PDCA-Cycle (W.Edward Deming)

lit y
y u a
a lit n t s Q t
Qu eme u ou men
a g tin v e
n n o
Ma ystem Co Impr
S
Effects of Continuous Quality Improvement

» Detects resources and synergies

» Optimizes workflows /processes and systems

» Improves the product / service and customer satisfaction

» Optimizes the use of resources

» Supports skills, creativity and commitment of the employees

» Improves team work and corporate culture

» BUT can also increase the “pressure to perform” for

employees
… rowing is not enough!
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management
 Quality Management Systems used in health care
organizations
 Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality
Platform www.qualitaetsplattform.at
 Detailed Information about the questionnaire for quality
reporting
The Quality Platform: www.qualitaetsplattform.at
The Quality Platform: www.qualitaetsplattform.at

Project goals:
» Regular, nationwide quality reporting on key indicators for quality
structures and processes in Austrian hospitals  Benchmarking &
incentive to build capacities
» Sharing information about various projects  community of
practice
» Data collection via an access-protected website:
www.qualitaetsplattform.at

structure database project database

Development of „The Quality Platform”

» until 2004: previous project www.qbe.at - no report

published
» 2008, 2009: Evaluation and revision of the previous
questionnaire (How should the report be designed, What
kind of information should be in it?)
 Interviews, questionnaire survey, evaluation workshops,
expert panels
Goal: questionnaire about structures and instruments of
quality work in Austrian health care institutions
» 2010: Completing the questionnaire, programming the new
website and launching the new quality platform at a national
quality conference
General Framework

Contracting authority:
» Federal Health Agency (Bundesgesundheitsargentur)

Policy framework “Quality reporting”

» The Act on Health Care Quality (Gesundheitsqualitätsgesetz)
» Austrian Quality Strategy (Qualitätsstrategie)
» 2011: Amendment of Law on Hospitals
(Krankenanstaltengesetzt)  mandatory participation (before
participation was voluntary)
Topic Points

 Introduction Gesundheit Österreich GmbH

 Definition and evolution of Quality
 Total Quality Management
 Quality Management Systems used in health care
organizations
 Continuous Quality Improvement
 Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:  The Quality Platform
www.qualitaetsplattform.at

 Detailed Information about the

questionnaire for quality reporting
The Quality Platform: structure database

Main content points

» General description
» Structural embedment of quality work
» Quality Management Models
» Quality work
Indicators - structure database

Structural embedment of quality work

» Mission statement
» Quality strategy
» Quality Assurance Commission (staffing, internal regulations)
» Coordination of quality work (organisation, staffing, qualification)
» Quality management models (ISO, EFQM, CJ)
» Quality work
o Processes/Standards
o Admission/Discharge procedures
o Operative management
o patient-orientation
 Rights of patients (information, trainings)
 Patient satisfaction survey (topics of questionnaire, intervals,
results)
Indicators - structure database

o Employee-orientation
 Employee satisfaction survey (topics of questionnaire,
intervals, results)
 Structured staff appraisal
 advanced training (documentation, coordination)
 workplace health promotion
o Suggestions and complaints (survey method, handling,
analysing, employee suggestion system)
o External quality-projects
o Patient Safety and Risk Management (instruments,
reporting systems organisation, staffing, qualification)
o Continuous Quality Improvement
Example for evaluation graphic

In how many departments there are defined contact persons for

risk management? (n = 82)

Response: in all/in many/in

some departments
Example for evaluation graphic

Quality models in Austrian hospitals > 80% of KH have a Quality

Model implemented or a planning to do so
The Quality Platform: project database

» Name of the project

» Contact person

» Timeframe for the project

» Brief description of the project

» Target group

» Project orientation (patient,

employees, relatives, public...)
» Evaluation
Benefits of „The Quality Platform“

» Transparency: National overview of structures, tools and

projects in hospitals and rehabilitations centres

» Benchmarking: the individual organization can benchmark

itself with the Austria-wide results

» Automated analysis and download their own data (eg internal

reports)

» Networking, information and experience for members

» Information section on the website of the quality platform

(link collection, downloads, etc.)
Other Initiatives

» Nationwide uniform survey on patient satisfaction

across sectors

» Austrian Inpatient Quality Indicators – A-IQI

 „Evidence of effective change
+
Effective implementation method
+
Supportive environment and infrastructure
=
Improved quality“

Source: Øvretveit, John (2009): Does improving quality save money? A Review of Evidence of which Improvement
to Quality Reduce Costs for Health Service Providers. The Health Foundation, London
Thank you for your
attention!