UEMS QUALITY ASSURANCE OF CLINICAL PRACTICE Edwin Borman

THE QUALITY AGENDA QIQA QC ImprovementAssurance Control

STAKEHOLDERS Healthcare Quality Doctors SocietyPatients Fund-holders Employers Regulators

QUALITY ASSURANCE the regular review against defined standards of clinical practice requires all stakeholders to acknowledge their responsibilities in the delivery of high quality healthcare

WHY IS Q.A. IMPORTANT ? REVIEWING:current practice LEARNING:from good examples IMPROVING:standards AFFIRMING:accountability PROVIDING:resources

ACCOUNTABILITY IN CONTEXT doctors should be able to demonstrate their continuing fitness to practice by engaging in a suitable QA process QA must consider the full context: doctors, healthcare teams, work environment

THE Q.A. CYCLE Q.A. Introducing improvements Setting standards Reviewing results Monitoring practice

SETTING STANDARDS Solid evidence base Medically - led Requires consensus Many models exist Not uniformly applicable

MONITORING PRACTICE PERFORMANCE :what a doctor does COMPETENCE :what a doctor knows OUTCOMES AS PERFORMANCE INDICATORS measures of the results of practice direct, or indirect

REVIEWING RESULTS INFLUENCES ON OUTCOMES Individual:case-mix collective:team contribution global:resources, environment STAKEHOLDER CONFIDENCE methodologies and outcomes recognised by all as valid

THE WORKING ENVIRONMENT Visitation programmes trained inspectors defined criteria emphasis on developmental reports EXTERNAL AUDIT BY PEER REVIEW

THE HEALTHCARE TEAM Team-based focus INTERNAL DEPARTMENTAL AUDIT Individual and collective review of practice EXTERNAL AUDIT BY PEER REVIEW

INDIVIDUAL DOCTORS CRITERIA –knowledge, skills, behaviour, outcomes METHODS –audit –peer-review –surveys

THE NEED FOR RESOURCES AN ABSOLUTE REQUIREMENT –time–money –people –information technology OPENNESS PROMOTES ACCOUNTABILITY It is the responsibility of the body that requires Q.A. to ensure that this is adequately resourced

THE UEMS PROPOSAL THE Q.A. CYCLE IS ESSENTIAL MONITORING ALL TIERS OF HEALTHCARE ITSELF SUBJECT TO REGULAR REVIEW INCLUSIVE OF ALL STAKEHOLDERS VALID OUTCOME MEASURES DEVELOPMENTAL INTERVENTIONS EXAMINING OUTLIERS

COMPULSORY SYSTEMS? There is no evidence that demonstrates the additional effectiveness… of such mandatory systems It is inappropriate to focus on only one component of a multi-factorial system