Quality dimensions in health policy state of the art & visions of the future

1. Quality dimensions in health policystate of the art & visions of the future Marek Haber Deputy Minister of Health

2. Main determinants of quality-oriented policy • Equal access not only to healthcare, but also to high quality of care (constitutional requirement), • Investing in quality results in savings from less healthcare-associated infections, complications, readmissions, etc., • Improving the quality in healthcare is recommended by EU, the Council of Europe and other international bodies.

3. National Center for Quality Assessment in Health Care (CMJ) • From 1994 CMJ is responsible for managing the healthcare quality issues in Poland, • From 1997 a national accreditation is granted to hospitals meeting the criteria, • Law dedicated to accreditation scheme was introduced in 2008.

4. Projects with CMJ involvement • WHO PATH: „Project Performance Assessment Tool for Quality Improvement in Hospitals” – first initiative in Poland aiming at improving the quality inside the polish hospitals. The main benefits were: - monitoring the activity (also the clinical outcomes) in multidimensional approach to the hospital evaluation, - providing the tool to initiate and support internal quality improvement schemes, - acquiring educational and technical support.

5. Projects with CMJ involvement • Marquis „Methods of Assessing Response to Quality Improvement Strategies”, - evaluation and comparison of various healthcare quality policies in EU member countries, - identifying quality requirements, - developing base for EU-level recommendations on quality healthcare.

6. Projects with CMJ involvement • Handover: „Improving the Continuity of patient care through Identification and implementation of novel patient handoff processes in Europe”, - Identifying and developing best patterns of communication and standardization of information exchanged during the patients transfer between different healthcare levels, - developing the EU-level recommendation on safe and effective communication during the patients transfer.

7. Projects with CMJ involvement • OECD HCQI: “Healthcare Quality Indicators Project”, - comparing the selected quality indicators, which are significant for the quality of care in different areas of healthcare.

8. Quality in guaranteed benefit basket • In healthcare service act and in related regulations the minimal set of requirements is given, regarding the medical equipment, staff or organization of care, • For selected kinds of care the requirements are higher (for example rare cancer surgeries – pancreas etc.). The rationale is to direct patients with certain diagnoses to reference centers providing the highest quality.

9. The accreditation act • Set of norms for primary and specialistic ambulatory care, • To receive accreditation, healthcare institution must ensure higher standards than required in law related to guaranteed healthcare service act.

10. Current quality-oriented policies • Package of acts restructuring the healthcare providers is currently being proceeded in the Parliament, • At the same time quality regulations are being prepared. Their framework will depend on the final version of proceeded acts.

11. Principles of the new Quality act Main goal of new regulations is to ensure: - patient safety, - effectiveness of care, - efficiency of care, by developing the universal system of quality monitoring, and thus assurance, for healthcare services financed from public resources.

12. Principles of the new Quality act The goal of the new law is expected to be achieved by: • implementing the mandatory reporting system, based on the commonly accepted quality indicators and standards, • motivating the providers to improve quality through differentiating the financing level.

13. Principles of the new Quality act The act will be mainly addressed to: • The public payer (National Health Fund), • Healthcare providers who have signed contracts with the public payer, • Patients.

14. Principles of the new Quality act • In early stage most of hospitals will be included, gradually the system will be extended to other levels of healthcare, • The monitoring and financing system must be maximally objective and transparent.

15. Principles of the new Quality act • In early stages the monitoring should rely mainly on the existing, routine reporting system, • It should be based on existing structures – statistical departments, infections workgroups and comittees, etc.

16. Principles of the new Quality act • The monitoring system will be tested for 6-12 months without the financing effect (only monitoring indicators), • During this period hospitals will also receive reports on the potential budget impact,

17. Accreditation in new system • Accreditation will function according to present rules, on voluntary basis, • The certificate will have more impact on the contracting scheme.

18. Accreditation in new system Prevalence of acreditation: • Stimulating the increase in number of certificates granted to hospitals, • Developing accreditation standards for different levels of healthcare.

19. The project is expected to be widely consulted in the first half of 2011.

20. Thank you for attention!