1. UEMS QUALITY ASSURANCE OF CLINICAL PRACTICE Edwin Borman

2. THE QUALITY AGENDA QIQA QC ImprovementAssurance Control

3. STAKEHOLDERS Healthcare Quality Doctors SocietyPatients Fund-holders Employers Regulators

4. 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

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

6. 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

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

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

9. 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

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

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

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

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

14. 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

15. 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

16. 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