Quality
is a key topic for all discussions in health care. National
policy is seen as a means for incorporating all existing quality
activities and adding missing methods and tools to an organised
framework of quality improvement system.
Who
National
level
National
government and national health care policy makers are responsible
for the quality of the health care system.
Accessibility,
availability and affordability of appropriate quality health
care services that are evenly distributed throughout the country
that ensure equity to all the citizens and fulfil the needs
and expectations of the population is the main objective of
the health policy on national level.
Regional
level
Regional
health care authorities have to implement these policies by
joining the payers, health care providers and representatives
of lay population to decide on common priorities.
Regions
in our country are in a way underdeveloped and therefore deserve
special attention in future quality initiatives.
Local
level
Inspite
considerable privatisation processes the majority of health
care is still and is going to be rendered by the providers in
public sector under the national managed health care plan. So,
the role of managers in these institutions is becoming increasingly
important but distinctively opposite as it used to be in the
past. The managers are no more the transmitting force of the
central authorities. They have to become the driving force of
quality metamorphoses by providing sound basis for all quality
activities within their institutions. They have some important
tasks:
First
task: They have to create quality policy of the organisation,
design quality improvement system, prepare the quality manual
and delegate responsibility for quality matters to the quality
manager and managers on lower levels of the organisation. Every
member of the organisation have to be involved in quality activities
to the level he/she is in a position to add to quality improvement.
Involvement of the staff can only be achieved by clear information
on the goals they must achieve and concrete responsibilities
they have. In many organisations this goal can be achieved only
by restructuring the management system of the organisation by
creating horizontal levels of responsibility for the professionals
and with vertical management structure supporting the process.
Second
task: The leadership of the organisation has to develop a plan
of the organisation, define explicit goals that need to be achieved
and identify the providers who are responsible for the fulfilment
of the goal (or part of the goal if necessary). The e goals
must be presented to the staff in their language and to the
extent they need to be informed. health care professional must
know the goals of their organisation in order to strive themselves
to achieve common goal.
Third
task: By promoting (financially and morally) and implementing
quality policies on all levels of the organisation they encourage
incentives and innovative processes of all members of the staff.
They have to create a system of incentives to participate and
achieve pre-set targets. Together with professional they have
to define these targets and decide on the use of eventual savings
that may occur due to quality activities.
Fourth
task: They have to monitor and evaluate the quality improvement
system of the organisation itself.
Health
care professionals
And
where are we - the professionals.
We
consider this top down approach as sine qua non for the quality
improvement. In industry the leadership of the organisation
can successfully enhance the quality processes. But in the health
care the majority of the processes are very complex and done
by variety of professional. This together with a multitude of
the processes and variation in patient mix, provider and health
care setting characteristics makes controlling the process of
care on a simple and cost effective manner practically impossible.
So the quality improvement activities of the providers themselves
are the key to success of quality improvement.
On
the other hand, solely action of the health care providers (bottom
up approach) without management support (as it happens in many
cases) is surely not enough and damned to failure.
Only
joint action of supportive leadership and knowledgeable, dedicated
and highly motivated professionals can be successful.
National
policy on quality in health care can render the vision of the
framework for quality in the country. Methods and tools for
implementing policy and quality activities in daily routine
are the next step towards better quality: Strategy to improve
quality in health care. Diabcare is a project that uses the
best known practices to achieve superlative quality and serves
as a model for quality improvement methodology in other areas
in health care.
How
to develop and implement national policy on quality in health
care
Developing
of national policy will take several steps and is an ongoing process.
Today we present the first draft on common principles for quality
improvement. Part on current activities and future programs will
arise from discussions in the professional bodies on national
level. Because we consider the best strategy to implement policy
is the professionals are involved in developing process from the
early beginning and have possibility to decide on priorities within
each profession. The draft of national policy will be distributed
to the professional associations of each speciality and to all
profiles of providers in health care, to the ministry of health,
national insurance institute, to the association of consumers
and other interested parties. In three month period we will gather
ideas on common section and proposals for programs and future
activities. After reaching consensus on the basic principles we
will prepare a national conference with inauguration of proposal
of national policy. This can happen late in autumn this year.
Adding
results from Oratel, Obsquid and Diabcare has several implications
for implementation of the policy: building in the success of
these areas can encourage providers in other areas of health
care provision to start quality improvement activities, broad
network for data collection in these projects can serve as a
model for information driven quality improvement.
Resources
Allocation
of resources for quality activities is one of the priorities
to be decided on national level and also within each provider
organisations. Since, the need for quality improvement efforts
is very well recognised, I assume that funding quality improvement
system in our country should not be the problem as it is at
the moment. Advisory board of the minister for health has accepted
an initiative to create a national policy on quality in heath
care. In a very constrained health care budget we must find
resources to develop and implement quality improvement systems
on all levels of health care. Mutual efforts can bring a gradual
improvements towards better quality of care in Slovenia.
