Invitational Conference January 24. 2019

1. Invitational Conference January 24. 2019

2. Executive vice president Erik Jylling Danish Regions Quality in Danish Health Care – Moving from accreditation to an improvement approach

3. The Danish Healthcare System • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme • Agenda

4. The Danish Healthcare System Free & Equal Access Universal Coverage Financed by general taxes A high degree of decentralization

5. Healthcare expensesbelow OECD average Healthcare expenses, % of GDP 2018 Ireland Iceland Norway Denmark Finland Belgium Netherlands United Kingdom Italy Sweden Greece Spain Portugal Austria Canada Germany Switzerland France USA Health expenses per inhabitant 2018 - dollars Finland United Kingdom Denmark Sweden France Netherlands Germany Norway Source: OECD Health Data – 8,6 OECD average

6. Organization of the Healthcare System 5,8 millions inhab.

7. The Danish HealthcareWho is responsible for what? • State • Legislation • National health care policy • The overall framework of the health care economy • Specialty planning • Regions • Hospital (somatic and psychiatric, in- and outpatient) • Primary healthcare contracts (GP, specialists in private practice, adult dental services, physiotherapists, psychologists, chiropodist, chiropractor) • Reimbursement of medicine • Municipalities • Home care • Rehabilitation services outside hospitals, • Treatment of drug and alcohol abuse • Prevention and health promotion • District nurses • Children's dental services

8. Disruptive Forces The Basic Change in Health Care Conditions

9. Agenda • Danish Regions and the 5 regions • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme

10. The National Quality Program From qualitycontrol to qualityimprovement Qualityplanning Qualityplanning Qualitycontrol Qualityimprovement Qualityimprove-ment Qualitycontrol

11. GuidingPrinciples of the Quality Programme • A sharedquality programme for the 5 regions og 98 municipalities • Acrosssectors,includes the entire patient pathway (primary- and secondarycare) • Value and outcome for the patient is the overlyingprinciple • Improvementworkaccording to the localneed for qualityimprovement (bridginglocalqualitygaps)

12. The Stepping Stone The Danish Model for Accreditation • Focus on qualitycontrol and assesment of hospitals • Systematisation of the qualitywork • Strong management focus to comply with the standards We must takethesewinnings with usgoing forward!

13. Political agreement to end hospital accreditation ”Qualitywork must besimplified and focused. The time has come to strengthen it by putting the patient at the centre, ratherthanfocusing on compliance with a variety of standards. Accreditation has beenjustified and useful, but wemove on. Weneed a few national targets to bemetlocally with strongcommitment from the staff and with room for local solutions.” Bent Hansen, Former president of Danish Regions, April 2015

14. Keep the Winnings • The down side to accreditation • Lack of meaning from a clinicalperspective • Introduced a number of registrations, documents and policies • Focused on controlinstead of actualimprovementwork • Demotivatedstaff • Gains from accreditation • ImprovedQuality • Professionalism, necesary standards and systems in place • Strong leadershipfocus on quality

15. Agenda • Danish Regions and the 5 regions • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme

16. System for Improvements Health Care system units Qualityimprovement Control Supervision Innovation Quality Excellent quality Unacceptablequality Control and commandCooperation and trust Users vioceCompetition Steeringparadigms

17. A Shift Towards a Dynamic, Patient and ClinicalOriented Approach The core of the new qualityprogramme is an ambition to continuouslyraise the quality of healthcare • It demandsthatwe … • Implement bestclinical practice quickly • Learn from eachotheracrosssectors and regions • Work systematically with real time data • Have leadersthatcan drive improvement • Have confidence in the healthcare professionals

18. Data for Value and Health Outcome for the Patient To assessqualityimprovement and healthoutcomes of our services weneed to: • Make data on Patient-ReportedOutcomeavailable – alsoacrosssectors • Use more timely data – directlyinto Business Intelligence Systems • New types of data? • Danish National Clinic registers

19. Agenda • Danish Regions and the 5 regions • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme

20. Key Elements in the QualityProgramme 8 national targets for the healthcaresector A national leadershipprogramme Learning and quality teams

22. A ”Traffic light” model

23. A programme for all sectors of Health Care in Denmark

24. Agenda • Danish Regions and the 5 regions • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme

25. Key Elements in the QualityProgramme 8 national targets for the healthcaresector Learning and quality teams A national leadershipprogramme

26. Learning and Quality Teams • Expert group: • Consists of leadingclinicians in the field, improvementexperts, patient representatives and peer-experts. • Sets goals for improvements and defines bundels to beimplemented • Support the teams • Departments: • Do systematic datadriven improvementwork • Involve patients and patients perspective in the improvementprocess • Local adaption of bundels Dep A Dep H Dep. B Expert Group Dep G Dep C Dep F Dep D Dep E

27. Learning and Quality Teams

28. Agenda • Danish Regions and the 5 regions • The National Quality Programme • Shift in Steering Model • Key Element 1 8 National Goals • Key Element 2Learning and Quality Teams • Key Element 3 The National Leadership Programme

29. Key Elements in the QualityProgramme 8 national targets for the healthcaresector A national leadershipprogramme Learning and quality teams

30. A national leadership programme • A national leadership programme for ‘leaders of leaders’ in healthcare • Hospital and primarycareleaderstrainedtogether • Building capacity and capability of qualityimprovementleadership • One programme a year in 4 years

31. Leadership is the Key! Leaders on all levelsneed to • Know theirown data and practise • Know the golden standard • Be patient centered • See qualityimprovement as an inherent part of doingtheir job • Coorperate with others to improve the entire patient pathway, not just theirown ‘business’

32. The National LeadershipProgrammeRelates to the Other Key Elements • Learning and quality teams • Support teams in department and hospital • Support dataanalysis at department and hospital level • Follow up on data and improvement • National targets • Works with qualityimprovement at locallevelwhichleads to betterresults in the 8 national targetareas (measured by 21 indicators) National leadershipprogramme Capacity and competences to be the leader of datadriven, clinicalqualityimprovement

33. VISIONS for the Future Learning and Quality Teams for each areas of diseases How are you today? Professionals daily engaged in quality improvement Continue the use of indicators Continuously challenge and improve quality A joint Quality Organization Include the entire ”patient journey” Use of timely data (incl. PRO-data)

34. Next step: Evaluation and development • Whole healthcare system (incl. GP and primaryhealth) • New organisation and governance of healthcare (clusters) • Value basedhealthcare • LKT – more differentiated model • Leadership program more differentiated • Improvement science

35. Thankyou for your attentionWWW.REGIONER.DK