1. Quality control of gynecological operations in Sweden: How and what? GYNOP Swedish National Quality Register of Gynecological Surgery www.gynop.org

2. Emil Nüssler HOW? Measurements for Improved Quality in Healthcare Singapore China India Scotland England Australia Canada +Denmark +Germany + …. TOP – DOWN Government + departments... Quality indicators Recommandations Standards Certification Accreditation National statistics

3. Emil Nüssler Sweden + Australia? BOTTOM – UP…. Enthusiasts + nerds... HOW? Measurements for Improved Quality in Healthcare

4. Emil Nüssler Sweden BOTTOM – UP…. Enthusiasts + nerds... Rapidly growing number registries in the nineties 1997 Gynop 2007 ”the local authorities and regions took the responsibility of the continuing operation, development, and financing of the registries” HOW? Measurements for Improved Quality in Healthcare

5. Emil Nüssler Sweden BOTTOM – UP…. Sweden today... 8 ”competence centres” 78 ”accepted” national quality registries 24 ” candidate” registries HOW? Measurements for Improved Quality in Healthcare

6. Emil Nüssler Database Laparoscopy Hystero- scopy HOW? The gynaecological family 1997

7. Emil Nüssler Database Benign abd. surgery Adnex Hystero- scopy Malignant tumours Prolapse Incon- tinence HOW? The gynecological family since 2006

8. Emil Nüssler Pre-op questionnaire Questionnaire 1 year post-op Questionnaire 8 weeks post-OP PATIENT DOCTOR

9. Emil Nüssler Pre-OP questionnaire Questionnaire 1 year post-OP Questionnaire 8 weeks post-OP Status at ADMISSION OPERATION Status at DISCHARGE PATIENT DOCTOR 8 weeks - assessment 1 year - assessment

10. Emil Nüssler CARE oriented Medical perfection PATIENT oriented Fitness for purpose MANAGEMENT oriented Value for money WHAT? QUALITY?????

11. Emil Nüssler on NATIONAL LEVEL ? What do we do with our data? COMPARISON

12. Emil Nüssler  Uninformative for the clinician on NATIONAL LEVEL = What do we do with our data? COMPARISON

13. Emil Nüssler  Uninformative for the clinician  Irrelevant for the patient on NATIONAL LEVEL = What do we do with our data? COMPARISON

14. Emil Nüssler  Uninformative for the clinician  Irrelevant for the patient  Boring, for quality-minded professionals on NATIONAL LEVEL = What do we do with our data? COMPARISON

15. Emil Nüssler COMPARISON on CLINIC + INDIVIDUAL LEVEL ?

16. Emil Nüssler COMPARISON ”IMPOSSIBLE” on CLINICAL + INDIVIDUAL LEVEL =

17. Emil Nüssler COMPARISON ”IMPOSSIBLE” because of …. CASE MIX……… POLITICS……… MONEY………… EGO……………. TRADITIONS…....anything goes.. on CLINIC + INDIVIDUAL LEVEL =

18. Emil Nüssler COMPARISON YES WE CAN… Comparable Patient Groups Dynamic Benchmark on CLINICAL + INDIVIDUAL LEVEL =

19. Emil Nüssler COMPARISON on NATIONAL LEVEL

20. Emil Nüssler COMPARISON on CLINICAL LEVEL version 2006 Einfache Prolapsoperationen

21. Emil Nüssler Einfache Prolapsoperationen Dynamic Benchmark COMPARISON on CLINICAL LEVEL version 2009

22. Emil Nüssler Einfache Prolapsoperationen COMPARISON on CLINICAL LEVEL version 2012

23. Emil Nüssler What do we do with our data? Production reports Special reports ”Open report” (Öppna Jämförelser) Gyn. Departments ”annual report” Scientific research ”for all” Scientific research ”for all” Pre-op information of patients Clinical data + ”Rapportgenerator” Clinical data + ”Rapportgenerator”

24. Quality control ain’t easy….. Thank you for listening! emil.nussler@gmail.com Swedish National Quality Register of Gynecological Surgery www.gynop.org