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Improving Hospital Performance creating synergy between quality, efficiency and payment models

Improving Hospital Performance creating synergy between quality, efficiency and payment models. Niek Klazinga, Bucharest, March 25 2011. .menu. The life cycle of hospitals Strategies to improve quality of care Measuring hospital performance Synergy between quality and efficiency

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Improving Hospital Performance creating synergy between quality, efficiency and payment models

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  1. Improving Hospital Performancecreating synergy betweenquality, efficiency and payment models Niek Klazinga, Bucharest, March 25 2011

  2. .menu • The life cycle of hospitals • Strategies to improve quality of care • Measuring hospital performance • Synergy between quality and efficiency • Synergy between quality, efficiency and payment models

  3. The life cycle of hospitals • 19th century roots • 20th century: golden age of the hospital as a modern high tech industry with specialized work-force focused on clinical medicine • 21th century: decline and transformation of hospitals

  4. The life cycle of hospitals • Less need to concentrate the technology associated with clinical care in one location (smaller and portable equipment for diagnoses and treatment). • Less need to concentrate all clinical functions in one location (ICT) • Gradual shift towards dealing with the acute phases of chronic diseases

  5. The life cycle of hospitals • Emergency care in local health posts and ambulances • Shift from in-patient care towards day-care and out-patient care • Shift towards long-term care (nursing homes, home care) • Shift from specialization towards generalization in the professional workforce

  6. Types of Hospitals • Ownership public or private • Not-for profit hospitals • For-profit hospitals • Nature and level of specialization of clinical functions • Teaching • Research

  7. Quality Strategies • Results of the EU funded Marquis project • Theme issue Quality and Safety in Health Care. February 2009, Vol.18 Supplement 1

  8. Strategies studied 1- External pressure 2- Organizational quality management programs (TQM) 3- Audit, internal assessment of clinical standards 4- Patient safety systems 5- Clinical practice guidelines 6- Performance indicators 7- Systems for getting patient views

  9. Participation in the study

  10. Analysis of strategies inter-connection Clinical guidelines Performance indicators Patients’ safety 47% Organizational quality Audit and internal assessment Patients’ views Exploratory Factor Analysis: Total variation explained Cronbach’s alpha=0.724 N=389

  11. Summary of preliminary recommendations:(EU level supporting hospitals) • It is recommended that hospitals work on combining quality strategies instead of focusing all the efforts on one of them, since we found that the quality strategies studied are part of one single construct. • We did not find any evidence of effect of ownership or teaching status in any output measure. There is no reason for differentiating QI strategies to be promoted based on teaching / ownership hospital status. • We recommend to promote external assessment of hospitals, and consider that the type of external pressure should be accommodated with the goals and context of health care delivery • Support further research to further develop and validate the maturity index on the hospital’s quality management system and to promote its use by healthcare organizations.

  12. Measuring Performance • Avoidable Hospital Admissions • 30-day case fatality rates for AMI and Stroke

  13. Avoidable hospital admission rates, 2007 Note: Data from Austria, Belgium, Italy, Poland, Switzerland and the United States refer to 2006. Data from the Netherlands refer to 2005. 1. Data does not fully exclude day cases. 2. Data includes transfers from other hospitals and/or other units within the same hospitals, which marginally elevate the rates. 3. Data for CHF includes admissions for additional diagnosis codes, which marginally elevate the rate. Source: OECD Health Care Quality Indicators Database, 2009

  14. Synergy quality and efficiency Differences between efficiencies on department, hospital and whole system level Value creation perspective (Porter et al) Waste perspective (RAND) Quite often existing payment systems do not allow a business case for quality

  15. Synergy between quality, efficiency and payment models • Assess hospital performance from a whole system perspective • Focus on process as well as short and long term outcome indicators • Align the hospital infrastructure with the changes in the hospital life cycle • Align the interests of management and professionals • Adapt incentive structures including pay-for-performance models

  16. . • Multumesc pentru atentie • Sunt deschis pentru orice intrebari • niek.klazinga@oecd.org

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