Sunday, 31 March 2013


The interest in quality management in healthcare has increased in the last decades as the financial crises in most health systems generated the need for solutions to reduce costs while maintaining quality of care. The development of quality management procedures has been closely linked with healthcare reforms. Starting in the early nineties quality management issues took impulse in reform legislation only 15 years later.

It has been made a considerable progress in Europe, however, it is recognized that the full integration of quality management will require long-term commitment in developing methods, instruments and communication procedures. The most ambitious project nowadays is the development of a comprehensive comparative quality management system for hospitals at national level, including public reporting.

Quality management in health care is on the move in a constructive direction. However, it is expected that the fully integrated implementation of quality management will take many years. Reasons for the long process can be seen in the complexity: It requires a long-term system change and sound methodological development of indicators suitable to the national health system. It further involves the education of the health professionals in quality management and assurance methods. This may also reduce some reservations of the various stakeholders vis-à-vis imposed quality approaches.

Quality management represents itself as a technical and professional issue. For the time being the aspect of patient orientation, one characteristic of the responsiveness of a health system, remains a weak part. The recent establishment of patient representatives participating in quality discussions opens the way for strengthening the patient orientation aspect. However, it may take a long time and requires resources to empower patient representatives to the degree of being accepted as real partners in the discussions.

Challenges in ensuring quality data, as well as the weak evidence on the effectiveness of hospital quality strategies have been addressed in the literature. The evaluation of the quality management efforts in terms of quality and efficiency is an emerging subject for the future.

The implementation of quality assurance measures since the nineties initiated a process, which also affects changes in the health system culture: Traditional reservations need to be overcome for new patterns of interdisciplinary and interprofessional cooperation. A new "error culture" needs an environment where adverse events and mistakes may be discussed and analysed constructively. The patient/professional relationship and communication patterns need to change for achieving better patient orientation and informed shared decision making.

Sources: NHS, Health Research Policy & Systems, Juergen Breckenkamp.


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