What is pccu in a hospital

Quality management in the hospital

01.07.2019

We explain the different facets of quality management in German hospitals.

Quality is a constant companion in the health sector. Ideally, we need more of it and should raise our standards higher, further and faster. Now that quality and quality control have already been covered in our blog, the fundamentals of quality management in hospitals should now be explained again.

Quality management - an invention of industry

Quality management (QM) originally came from industry, especially the aerospace industry, and was only taken up later in medicine. A standard model for the various aspects of quality is shown below with a cake: What makes this specific piece of pastry good or bad?

According to Donabedian, this question can be divided into the areas of structure, process and result quality.1

Structure and process quality

First of all, the ingredients or structural quality are required: Has the baker used fresh milk and maybe even organic products or limited himself to the cheapest possible, but possibly less healthy and less sustainable products? And is the manufacturer a specialist company?

In medicine, too, structural quality is about the ingredients, i.e. already existing structures and minimum standards in the health system, hospital or practice. The quality of the existing supply structures is ensured, for example, through approval procedures (drugs, doctors, etc.), the obligation to set up quality management or minimum quantity regulations.

And the preparation and process quality are also important: Has the cake been in the oven long enough? Have hygiene standards and the recipe been observed? Or in relation to medicine: Have guidelines been followed? Are there Standard Operating Procedures (SOPs) and is the indication correct?

The crux with the quality of the results

In the end, what counts is the cake on the plate, i.e. the quality of the result. But it is precisely this point that is also the most complex. If one person's mouth watered at the sight of an excess of chocolate cream, the other might see expensive and superfluous calories. Outcomes are increasingly becoming the focus of the assessment of medical quality.

But: who determines what a “good” result is? A patient does not necessarily understand successful treatment to be the same as his doctor.2-5 And the more complex the disease process (e.g. in the case of multimorbid, chronically ill patients), the more difficult it is to define success or even to assign treatment effects to individual interventions.6

Good quality management therefore ideally checks all dimensions of quality and defines the desired standards. The methods range from advanced training for doctors to quality circle work and error management systems.

Quality management in hospitals and law

The legal basis for quality management is laid down in the Social Code (SGB) 5, Paragraph 135a.7 Accordingly, hospitals and practices must set up and develop quality management. Controls or consequences in the event of non-compliance are initially not anchored in the law. With little control overall, in the outpatient sector it is the doctors themselves, or their convictions, who decide on the design and extent of their own quality control.

Hospital quality management programs

If hospitals usually have more sophisticated QM systems, everything is less standardized in the outpatient sector (see above). Nevertheless, most practices essentially use two QM programs. The QEP - Quality and Development in Praxen® of the Association of Statutory Health Insurance Physicians (KV) and the pan-European EPA.8-9

Due to the systemic interweaving of practices and KV, the QEP is probably the most widely used QM evaluation and implementation program. Often, however, the somewhat more complex EPA developed by the AQUA Institute is also used. The offers differ mainly in one point: only the EPO works with benchmarking, for example by comparing practices of similar size.

Benchmarking in the future

A more realistic classification of the evaluation of various quality indicators is possible through benchmarking. It enables a good assessment of what comparable healthcare providers are doing and, ideally, leads to improvements through comparison. If you overcome the fear of comparison, the door to mutual help and feedback for the benefit of all is wide open.

Conclusion

With our system, heartbeat also attacks precisely here. In the long term, we want to enable our customers to compare the outcomes of their treated patients with corresponding reference values. In this sense, we also support the path taken in politics towards more transparency, so that not only CEOs and chief physicians know how well their own team is treating, but also those actually affected - the patients.

But back to our piece of cake. As customers, we too would want to know if something went wrong while baking, where to buy the tastiest birthday cake and where to buy the best wedding cake. This should apply even more to our health.