1. Séance académique - Academische zitting Collèges de Médecins - Colleges van Geneesheren Feedback en perspectieven Feed-back et perspectives Introduction – Introductie A. Perissino M. Haelterman

2. Introduction Origin of Colleges of Physicians Methodology for quality improvement

3. Origins In 1999, following the advice of the National Council for Hospitals, the Belgian Government created the Colleges of Physicians, in order to - evaluate the activity (in their specific field) - promote quality of care - orient health policy Nine colleges started their activities in 2000: In Vitro Fertilization, Emergency care, Intensive care, Dialysis, Geriatrics, Neonatal Intensive care, Radiotherapy, MRI and Cardiology Oncology and Medical Imagery started their activities in 2004

4. Methodology THE PRINCIPLES leading the setting up of the Colleges are :  legitimacy  expertise  representativeness  without coercion for the participating hospitals (even if registration is mandatory)

5. The activity of the Colleges is based upon the quality cycle Plan – Do – Check - Act Although there are some variations from one college to another, the main steps are : 0) to set up and define the organization of the Colleges 1) to define a strategy and to choose a theme 2) to define quality indicators to compare resources, processes and output in Belgian hospitals 3) to provide feed back, recommendations and guidelines for the field 4a) to promote improvement of quality and to change the management of the patient’s care in hospital units 4b) to report to the decision makers

6. Hospitals DO Collèges 1.Vision, Mission, Priorisation 2. Objectives, Data collection, Assessment 3. Diagnosis Feedback Guidelines Recommendations 4. Local or national Action Colleges Hospitals Local level : ad hoc correction quality improvement, process reengineering, … National level : structural change reimbursment, organisation, equipment, manpower, …. Texte CHECK ACT PLAN Quality cycles DO

7. Frequency Quality +Time Recalcitrant 16 % Late Majorit y 34 % Early Majorit y 34 % Precursors 16% Quality improvement

9. Similarities with peer-review  The Colleges of Physicians are easily accepted by peers influence positively professional behaviours by education rather than by repression.  Reviews, benchmark and feedback of the data stimulate physicians to reconsider their practices.  Global quality improvement further catalyzes positive outliers for progression.

10. Differences with peer-review  First particularity : the Colleges of physicians are supported by authorities and decision-makers.  Second particularity : the Colleges give the opportunity for broader local or nation-wide impact of inter- and multidisciplinary studies.  Third particularity : recommendations of the Colleges are taken into account by health decision-makers to improve health policy.