Paula Vallejo

Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project

Context: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients. Aim: This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients’ views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment. Methods: A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006. Results: 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies. Conclusions: Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.

Differentiating between hospitals according to the "maturity'' of quality improvement systems: a new classification scheme in a sample of European hospitals

Aim: This study, part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project focusing on cross-border patients in Europe, investigated quality policies and improvement in healthcare systems across the European Union (EU). The aim was to develop a classification scheme for the level of quality improvement (maturity) in EU hospitals, in order to evaluate hospitals according to the maturity of their quality improvement activities. Methods: A web-based questionnaire survey designed to measure quality improvement in EU hospitals was used as the basis for the classification scheme. Items included for the development of an evaluation tool—the maturity index—were considered important contributors to quality improvement. The four-stage quality cycle (plan, do, check and act) was used to determine the level of maturity of the various items. Psychometric properties of the classification scheme were assessed, and validation analyses were performed. Results: A total of 389 hospitals participated in a questionnaire survey; response rates varied by country. For a final sample of 349 hospitals, it was possible to construct a quality improvement maturity index which consisted of seven domains and 113 items. The results of independent analyses sustained the validity of the index, which was useful in differentiating between hospitals in the research sample according to the maturity of their quality improvement system (defined as the total of all quality improvement activities). Discussion: Further research is recommended to develop an instrument which for use in the future as a practical tool to evaluate the maturity of hospital quality improvement systems.

Implementation of patient safety strategies in European hospitals

Context: This study is part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on cross-border care, investigating quality improvement strategies in healthcare systems across the European Union (EU). Aim: To explore to what extent a sample of acute care European hospitals have implemented patient safety strategies and mechanisms and whether the implementation is related to the type of hospital. Methods: Data were collected on patient safety structures and mechanisms in 389 acute care hospitals in eight EU countries using a web-based questionnaire. Subsequently, an on-site audit was carried out by independent surveyors in 89 of these hospitals to assess patient safety outputs. This paper presents univariate and bivariate statistics on the implementation and explores the associations between implementation of patient safety strategies and hospital type using the χ2 test and Fisher exact test. Results: Structures and plans for safety (including responsibilities regarding patient safety management) are well developed in most of the hospitals that participated in this study. The study found greater variation regarding the implementation of mechanisms or activities to promote patient safety, such as electronic drug prescription systems, guidelines for prevention of wrong patient, wrong site and wrong surgical procedure, and adverse events reporting systems. In the sample of hospitals that underwent audit, a considerable proportion do not comply with basic patient safety strategies—for example, using bracelets for adult patient identification and correct labelling of medication.

Indicadores de calidad asistencial de GESIDA para la atención de personas infectadas por el VIH/sida

Resumen Los sistemas de garantia de calidad asistencial tienen una cierta tradicion en Espana y mucho mayor en los paises anglosajones, pero en el campo de la infeccion VIH es escasa su implantacion. Aunque ello podia ser comprensible al inicio de la epidemia por la incertidumbre que rodeaba a la enfermedad, desde hace varios anos existe suficiente solidez cientifica en muchos aspectos de su abordaje, concretada en numerosas guias de tratamiento y practica clinica. Esto ha inducido a GESIDA a realizar los presentes indicadores de calidad asistencial para la atencion de personas infectadas por el VIH/sida. Un comite de profesionales, con la asesoria del Instituto Universitario Avedis Donabedian, redacto un primer borrador, posteriormente evaluado por un equipo de asesores externos y expuesto en la pagina web de la Sociedad. Las sugerencias fueron en parte incorporadas al texto final, resultando un total de 66 indicadores (estructura: 5; proceso: 45; resultados: 16) en las siguientes areas: Condiciones estructurales, Diagnostico y evaluacion, Seguimiento e intervenciones de prevencion, Seguimiento de pacientes en tratamiento, Aspectos especificos en la mujer, Comorbilidades, Hospitalizacion, Indices de mortalidad, Formacion e investigacion. En cada indicador se especifican los apartados que garantizan su validez y fiabilidad: justificacion, dimension, formula, explicacion de terminos, poblacion, tipo, fuente de datos, estandar y comentarios. Finalmente, se seleccionaron 22 indicadores considerados como relevantes y que GESIDA entiende que todas las unidades VIH deberian monitorizar para conocer en todo momento sus resultados en esos aspectos de la practica asistencial y asi poder introducir medidas de mejora.

Quality requirements for cross-border care in Europe: a qualitative study of patients’, professionals’ and healthcare financiers’ views

Background: In the past decade the issue of patient mobility has emerged on the European health policy agenda. Although the volume of patients crossing borders to obtain healthcare is low, it is increasing continuously and, due to its legal, financial and medical implications, has generated considerable interest among health policy and other decision makers. However, there is little information available on the safety and patient-centredness of cross-border care and neither governments nor citizens have an explicit basis for comparing healthcare delivery in Europe. Methods: This study investigated the viewpoints of patients, professionals and healthcare financiers on the safety and patient-centredness of cross-border care. Qualitative interviews were carried out during 2005 and early 2006 with 40 patients, 30 professionals (doctors, nurses and managers) and 3 healthcare-financing bodies. Results: Although cross-border care has become a common issue in many European countries, there remain uncertainties on the side of each of the parties addressed—patients, professionals and financiers—with regard to the provision of cross-border care. One of the most striking results of this project is the current lack of research on systematic knowledge on the quality of cross-border care. Conclusion: Many of the issues identified through this research may have a potential impact on the quality and safety of cross-border care and will support further investigation and help shape the health policy agenda on patients crossing borders in European Union countries.

Making performance indicators work: the experience of using consensus indicators for external assessment of health and social services at regional level in Spain.

OBJECTIVES To describe a methodology and the results of projects combining consensus processes for indicator development with methods of external assessment of health and social services. METHODS Our methodology can be characterized by a four-step approach: (1) stakeholder involvement and creating an enabling environment, (2) using standardized consensus methods for indicator development, (3) using rigorous external evaluation methods to assess results and (4) developing and implementing quality improvement initiatives. We describe each step in detail and discuss factors of success and pitfalls based on our experience of applying the methodology in 648 health/social centres and reviewing overall 68,616 case records. RESULTS We observe in four sectors (assisted living, elderly health care, care for people with drug abuse problems, and care for abused woman) improvements in overall quality improvement rates, ranging from 9.5% to 65.6%. Improvements in overall rates are accompanied by reduction in range of up to 48.8. CONCLUSIONS The conscientious setting up of an enabling environment and the systematic involvement of professionals in designing indicators and setting standards is a key to improving performance. Our research may entail lessons for policy makers on the current debate on pay for performance models.

El marco sanitario y el entorno psicosocial de la población inmigrante magrebí en Cataluña

Introduccion: Este estudio pretende obtener informacion sobre el marco sanitario y el entorno psicosocial de la poblacion inmigrante magrebi en Cataluna, para orientar las actuaciones en planificacion y provision de servicios sociales y de las organizaciones que apoyan a este colectivo. Metodo: Se utilizo un cuestionario de creacion propia que explora aspectos sanitarios y psicosociales, incluidos los factores estresores y de apoyo social. La recogida de datos se realizo mediante encuestadores y en lengua arabe. Resultados: Se realizaron 403 entrevistas. La mayoria de los encuestados tenian tarjeta sanitaria y sabian a donde acudir para recibir asistencia. Los servicios mas utilizados son los de atencion primaria y urgencias hospitalarias. En atencion primaria, casi todos los encuestados reciben explicaciones, pero un 30% no las comprende adecuadamente. Se percibe que los profesionales sanitarios no tienen muy en cuenta las diferencias culturales o religiosas. Trabajo, vivienda, alejamiento familiar y legalizacion son factores estresores para mas de la mitad de esta poblacion. El apoyo social es bajo. Tres cuartas partes de los encuestados se sienten solos. Mas de la mitad de esta poblacion ve cumplidas total o parcialmente sus expectativas migratorias y un 11% considera estar peor. Conclusiones: Las principales areas de accion pasan por reforzar la informacion sobre condiciones de acceso al sistema sanitario, fomentar la interaccion social y el asociacionismo entre los inmigrantes, especialmente durante las primeras fases del proceso migratorio, y facilitar las actividades religiosas. Parece importante formar a los profesionales sanitarios sobre las culturas de origen.

[Study of the healthcare background and psychosocial environment of the Maghrebian immigrant population in Catalonia [Spain]].

INTRODUCTION The aim of this study was to gather information on the healthcare background and social environment of the Maghrebian immigrant population in Catalonia in order to guide the management and provision of social services and the work of the organizations supporting this collective. METHODS To gather data, we used a questionnaire exploring healthcare and social variables, including stressors and social support. Data collection was performed by pollsters in Arabic. RESULTS We performed 403 interviews. Most interviewees had a health card providing access to public healthcare and knew where to access healthcare. The most frequently used services were primary care and emergency departments. In primary care, almost all of the interviewees were provided explanations, but 30% were unable to understand them properly. Health professionals seemed to have inadequate awareness of cultural and religious differences. Work, housing, distance from the family, and legal status were stressful factors for more than half of this population. Social support was low. Three quarters of the interviewees felt lonely. More than half of this population had completely or partially fulfilled their expectations of migration, while 11% felt they were in a worse situation. CONCLUSIONS The main areas for improvement are the provision of information on conditions of healthcare access, promotion of social interaction, the use of associations for immigrants especially during the first phases of the migration process and facilitating religious activities. Health professionals should be provided with training in intercultural issues.

Diseño, implantación y evaluación de un modelo de gestión de la seguridad del paciente en hospitales de Cataluña

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

Derechos de los pacientes en los principales sistemas de acreditación hospitalaria

Resumen Objetivo Analizar como se abordan los derechos de los pacientes en los principales sistemas de acreditacion del mundo. Material y metodo Estudio de los principales sistemas de acreditacion hospitalaria existentes, empleando una metodologia cualitativa de analisis de textos. Los estandares de derechos de pacientes de los distintos sistemas de acreditacion son agrupados segun el tema que tratan. Se establecen 9 temas principales: Informacion al paciente, Intimidad, trato y apoyo emocional, Proteccion del paciente, Proteccion de la autonomia, Donacion de organos, Codigo de derechos del paciente, Expresion de quejas y reclamaciones, Etica de la organizacion y Nuevos derechos. Resultados No todos los sistemas de acreditacion estudiados incluyen un capitulo sobre derechos de los pacientes. A pesar de las diferencias observadas en la cobertura que los sistemas de acreditacion dan a los derechos de los pacientes, tanto por la profundidad de su analisis como por los aspectos concretos que cubren los estandares, todos los sistemas de acreditacion estudiados tratan este tema, aunque no sea en forma de un capitulo independiente. Conclusiones En la revision realizada se evidencia la creciente importancia del tema de los derechos de los pacientes en los sistemas de acreditacion.