Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg

1. Dr. Christof Veit BQS Institut for Quality and Patient Safety Dusseldorf / Hamburg Quality and Regulation. Experiences from the German Health Care System. London, 14th February 2013

2. Solidarity is a core social value in European culture. Good quality Health Care for each citizen is a central part of our European societies.

3. Self Government Ministry of Health: Framework for the Health Care System Self Government: Joint Federal Committee Sickness Funds Hospitals Practices Patients Services. Prices. Quality.

4. Self Government Regulation of Quality Regulation of Care Regulation of Quality Management

5. Self Government Regulation of Quality Regulation of Care Structure Process Case volume

6. Self Government Regulation of Quality Regulation of Quality Management Quality Management National mandatory benchmarking Public reporting Sample testing

7. National Mandatory Benchmarking Measurement areas: 30 Quality indicators: 289 (88% risk adjusted) Data sets: 3.600 Million 96.6% Hospitals: 1,605 98.2% Data validity: good (different validation procedures) Results: ranging from „requires national level intervention“ to „excellent“

8. Benchmarking: Projects. >30 Projects on the National Level: Hip- and Knee Replacement Cholecystectomy Gynaecological Operations Breast Cancer Operations Obstetrics Cardiac Pace Makers Coronary Catheters Heart Surgery Decubital Ulcers Community acquired Pneumonia Transplants .......and others

9. Distribution of quality indicators Indication Process Outcome (long term) (short term) 20% 20% 60% Admission Discharge Hospital Care

10. Nat. Institute Experts project offices National Mandatory Benchmarking 1,708 Hospitals in 16 States

11. % National Benchmarking Project Office Experts

12. % Struc Dialog Structured Dialog Project Office Experts numerical outliers

13. SteeringCommittee Structured Report National Committee and National Experts Correct! Check! Project Office Experts % qualitative outliers

14. Regional Learning. Project Office Experts regional meetings

15. Self Government Regulation and Culture

16. Self Government Patient involvement.

17. Quality Improvement starts with a narcistic wound: I am not as brilliant as I would love to believe. And besides of 1000 excuses: I could have done better. I do better.

18. personal responsibility and system design

19. Quality is team work. Sharing, networking institutions instead of castles.

20. Self Government Pay for Performance?

21. P4P Modell

22. Self Government You cannot replace primary motivation with financial incentives.

23. Pay for Performance Quality of health care is guaranteed by primary motivation.

24. Pay for Performance There also are limits to sanctions.

25. Quality and Market.

26. Market lives from differences. Trust comes from equal quality of care at all places. Quality improvement is about lowering variation towards better care. Good quality care + Patient’s choice.

27. But: market mechanisms also want to differentiate access to care. Prime offers for a smaller number of wealthy patients. Solidarity? We call it: the freedom of the free fox in the free hen house.

28. Quality rule: Work with motivation but without pain no change.

29. Self Government Quality: Regulation and Culture

30. Quality

31. www.bqs.de