QUALITY OF LIFE Can we measure quality of life?

1. QUALITY OF LIFE Can we measure quality of life? Motto: Health is a value that is appreciated by everyone! (Latin proverb) Prof. Rudolf Pullmann, MUDr., RNDr., PhD.– head of Institute of Clinical Biochemistry JLF UK and MFN Martin; member of Central Ethic Commission at Ministry of Health of the Slovak Republic,… Dušan Kompiš Ing. – Manager of Quality in the Martin Faculty Hospital in Martin; secretary of Technical Committee for accreditation of health care at SNAS Darina Bochničková Mgr. –Manager of Quality– assistant in Martin Faculty Hospital, Martin Bratislava, 18th May 2007

2. What does quality mean? Quality according the international norms ISO 8402:1996 and ISO 9000:2000 means : a) The totality offeatures/characteristics of entity that bear on its ability to satisfy stated or implied needs. b) Measure with which the set of features comply requirements. The life quality issue is the issue of values.

3. Goal of health care (according to the paragraph 2 of law 576/2004 on health care) • Health care is the set of activities performed by health care professionals...With aim to prolong the person’s life, to increase his/her life quality and to ensure the healthy development of future generations. Health care is a specific service based on ethical principals. It has to respect not even laws, directions and norms but patient’s individuality, too. Service (according ISO 9000) is a result created at interface between a provider and a customer (caregiver and patient). Principals of biomedical ethics (Belmond – USA, 1978), Barcelona declaration (EU 1998) and problems at concrete applying principles – are shown in an Appendix you have received during presentation.

4. Health care requires an confidential relationship of caregiver and patient Traditional models of mutual relationship: 1. 1. Paternalistic model a) obligation of professional expertise b) responsibility towards co-workers; • Independent model a) respect of the patient’s free will; b) abdication at professional dominance;

5. Current conceptions of mutual relationship: a) semi-paternalistic; b) with limited determined; c) elaborating of conflict and  consensus; d) interpretative; e) conception of partnership – „shared decision making“; f) spiritual sensibility.

6. This determined goal is in coincidence with: • EU program to support the quality - its aim is to improve life quality • WHO program: "Health for all in the 21st century” • EU program: HPH - health promoting hospitals • WHO recommendation about the mission of university hospitals (Paris 1994) • Programs: Healthy cities • Results of the WHO QoL Group ´93 project • Outcomes of worldwide research in the field of ethics and spiritual dimension of health with the obligation of telling the true and maintaining theethical and human principles • trend of health care development – integratedmedicine (institutes of integrated medicine), total approach of HC (health care) and integrated management systems

7. Main problems in applying of current conceptions They influence quality of life of the health professionals and patients: 1. Problems connected with communication between health professionals and patients and among health professionals : a) teaching of communication; b) possibilities of communication in daily care; c) roles on management level; 2. Information about strategy conflict –solving situations: a) different kinds of conflicts; b) modes of solutions;

8. Areas of conflicts they result from moral attitudes: 1. clinical bioethics of life beginning; 2. clinical bioethics of life ending – seniors, terminal care; 3. clinical bioethics in psychiatric care; 4. biomedical research; 5. allocation of resources. Another problems they result from non-complex structure of studies at medical schools (pastoral medicine, integrated medicine, management system)and from following non-complex provided HC.

9. Basic model of health care quality management system(Application ISO 9000:2000; ISO 9001:2000 and ISO 9004:2000 in health care) Continual improvement of the quality management system INTERESTED PARTIES CUSTOMER REQUIREMENTS SATISFACTION Management responsibility Measurement, analysis and improvement Resource management Product realization Improved QoL/QoH INPUTS OUPUT • People (QL and QH) • pharmaceuticals, drugs, medical supplies, mecal utilities, ... Added value – restored, maintained and/or improved QoH Conditions for GDP increasing Defined environment with clearly limited activities of health institutions(HI) (with right to choose the physician/HI, ..logical legislation Internal environment of health care institution

10. Atomisation of science and breach of its principles Atomisation of medical science breaches this principles even more System sciences, TQM, QMS, management system, EMS, but also recognition of human organism as a system are trying not to go away from the principle of the process of Creation and do not destroy conditions for life at atomisation of science and scientific branched. On the contrary, the science should be continual process of knowing and improving of QoL. Nowadays the medical science consists of 80 scientific branches. Only eastern medicine and developing integrated medicine with total HC are interested in the human being and in his/her QoL and QoH. QMS s výstupom QoH/QoL

11. What is necessary to realize? Who is responsible for health of individual and his/her life quality and to which extent What the health of populationdepends on? Other 7% Health system 17% Life style 51% Genetics 25%

12. Motivation of employees, organisational environment and productivity Motivation= all factors they support, evoke and co-ordinate an activity of workers to higher quality of work and to more effective fulfillment of goals. Motivation is based on: • Personal example of the managerand evaluation of his ethics and character; • Objective quality evaluation of work quality including an effect of human factors; • New life style headed to continual improvement of QoL; • Exploitation of abilities of workers • Optimalisation of processes; • Innovation of environment and on emphasis an importance of prevention; • Effective increasing of qualification; • Appreciation of achievements of individuals and teams; • Justified remuneration of individuals.

13. Basic conditions for health care quality measure and improvement Outcomes from the whole QMS and all processes have to be measurable. Health = status of total physical, emotional and social well-being, not only the absence of decease; the result of interaction among human body and social-economic, physical, chemical and biological factors of living and working environment as well as the way of life. • According to this definition the health is not measurable

14. Summary of definitions on health imperfections (WHO 1948, 1986) Health and quality of life are mutually interconnected but both have to be measurable when we want to measure/evaluate outcomes of processes, projects/programs in a given area; we show imperfections of the definition of health from this point of view: • according the definition the health is more about the expression of feelings; it does not give possibility to define quality characteristics (indicators) forcertain gender, age categories/ periods of life nor for specific health status; 2. it includes satisfaction of needs, claims and expectations of man in the material and social field which exceeds the borders of health into the health status and is rather related to the total life; 3. it does not consider that many processes and functions in the human body can be interferenced without man noticing it or feeling discomfort or illness; 4. in definition there are not mentioned the latest results of WHO QL Group´93 research, not even the results in the field of ethics and spiritual health (impact of faith on individual‘s health), which is also connected with the creative abilities of individual and his/her correct list of values... 5. status of well-being and satisfaction can be experienced by individualwith distorted dimension of health - physically healthy psychopath, murderer and on the other hand physically and mentally healthy individual suffering by hunger, bad weather or troubles and worries, does not cease to be healthy; or physically handicapped individual can be on a considerably higher quality of socio-emotional and spiritual health than above mentioned psychopath, murderer ...

15. Health quality =integrated sign of life quality Health quality compass TQM philosophy is often defined as a road to perfection ... Health quality = total individual characteristics of all dimensions including : physical, psycho-social (mental) and cognitive-spiritual (spiritual), throughout which individual gains the ability to satisfy specified or anticipated needs for fulfilling a mission, during the particular periods of life, which would be in accordance with the model of the free decision making and the life quality compass (with the model of health development). How amazing it is to feel the unity of the whole complex of phenomenon they seems to be incoherent in their primary understanding Albert Einstein

16. What is life quality and can we measure it? Official theory of the USA and UN defines life quality as the set of characteristics and/or features of the individual/society in three dimensions: (added ones are in blue): 1. health; the basic feature, according to the UN, is the life expectancy; it is also connected with healthy environment and ability to live healthy lives(healthy life style – seeLife quality questionnaireandimperfections of the definition of health – WHO; nutrition protocol, Life quality compass...); 2. educationincludes ability to speak foreign languages and to work with PC; it doesn’t express neither correctness of thinking and doing, nor creative skills for common good(in QMS is required qualification= education, practice, achievements and ethic of the leaders) 3. buying forceindividual/society;( objectivity of this indicator requires: a) price to be the monetary expression of the value (objectively evaluated level of quality) ... b) remuneration to be applied according to the objectively measured (evaluated) share on the creation of the new values.

17. What is life quality and can it be evaluated? All three dimensions of „health quality“ are more-less material – quantitative ones. Many people are interested in other dimensions as well, e.g.: - creative thinking, creative working; - „productive“ love ( love in a biblical context). Creative individual creates new values for society for common good. Love to work includes: joy from work, joy from helping others, professional pride , empathic communication but also humbleness.

18. Total approach to health care provision Total approach to health care provision = health care provided by health care professionals for all dimensions of health : physical, mental (psycho-social) and spiritual (cognitive-spiritual). The aim of this approach is to find out a cause of illness and to cure an individual. It uses advantages of western as well as eastern medicine. (Harvard – 1.Center for integrated medicine, in USA).

19. How can measurable/evaluated QoH and QoL indicators be defined? Function of physical and sensual organs in their mutual conditionality and interconnection (according to Chinese medicine). Examples of health quality indicators in specific dimensions - physical, mental and spiritual are mentioned in Appendix which have been given to you at presentation.

20. Level of science expresses a state of our knowledge. Great mysteries of the Universe should be a confirmation of our belief in a certainty of existence of its Creator for us. I also do not understand a scientist who does not accept presence of the Highest Intelligence as well as a theologist who does not accept progresses in the science. Wernher von Braun, scientist, regarded to as a father of the US space program Thank you for your attention