1. National Quality Policy ENQual workshop Paul BartelsJan Mainz

2. Jan Mainz, Danish Society for Quality in Healthcare The Danish Healthcare system Denmark has 5.3 mio. inhabitants The Danish Health Care System is mainly public owned and run The public health care services is financed by taxes The Health Care system is decentralized to 14 countries It is a fundamental principle, that all citizens should have free and equal access to health care services

3. Jan Mainz, Danish Society for Quality in Healthcare The Danish Healthcare system Freedom of choice of hospitals and improved options to change general practitioner 1 mio. admittance to hospitals per year 4.5 mio. ambulatory care contacts 32 mio. contacts to general practitioners

4. Jan Mainz, Danish Society for Quality in Healthcare What do we know about the quality of medical care in Denmark? Lack of documentation about how major diseases are treated in the health care system Few goals for the quality of medical care Lack of outcome assessment Lack of ressource evaluation Persisting variations Examples of underuse and overuse No formal monitoring system The principal quality problems and their prevalence and incidence are unknown

5. Jan Mainz, Danish Society for Quality in Healthcare Conclusion The Danish health care system has a documentation problem. We don’t know the potential quality problems or their magnitude A modern health care system should be able to document it’s goodness There is a need for formalized and systematic quality assessment promising quality improvement projects have been initiated

6. Jan Mainz, Danish Society for Quality in Healthcare How do we measure healthcare performance in order to implement quality improvement 1989First workshop on quality improvement in Denmark 1991The Danish Society for Quality in Health Care 1993The National Strategy for Quality improvement in health Key message: A bottom-up model for quality improvement 1993-2000A lot of initiatives: meetings, courses, seminars, projects etc. But: no formalized and systematic quality improvements The Danish experience

7. Jan Mainz, Danish Society for Quality in Healthcare The Danish Experience 1999 - 2000 The National Council for Quality Improvement The National Indicator Project The Good Medical Department National Clinical Databases Quality Declarations Secretariat for Clinical Guidelines Patient Safety and Risk Management Nationwide Patient Satisfaction Studies Project on intangible values Accreditation Programmes in Two countries (JCAOH and HQS)

8. Jan Mainz, Danish Society for Quality in Healthcare The Danish Experience The Ministry of Health The National Board of Health The County Counselors’ Organization The Danish Medical Association The Danish Nurse Association Danish Physiotherapists The organization of Occupational Therapists The Danish Medical Scientific Society The Danish Scientific Nurse Society The National initiatives are a concerted action between:

9. Jan Mainz, Danish Society for Quality in Healthcare The Danish Experience 2002 A new National Strategy for quality improvement - Specific goals for 2002-2006 - Specific plans for actions 2002 -2006 Topics in the National Strategi: - Consumer involvement - Patient safety - Transparency - Development of competence Development of a Danish model for Quality Improvement - Should be presented in 2003

10. Jan Mainz, Danish Society for Quality in Healthcare Principles in the National Model Quality improvement should be related to patient clinical pathways Development of a Danish set of standards and indicators (Alpha-assessment) Generic and disease specific standards should be included Integration of existing national initiatives Transparency – Public disclosure of quality of care data

11. Jan Mainz, Danish Society for Quality in Healthcare Principles in the National Model Selfassessment should be part of the model External evaluation in collaboration with an international accreditation organization The Danish model should comprise both the primary health care system and hospitals The Danish Health Care system should be accreditated before 2006

12. Jan Mainz, Danish Society for Quality in Healthcare The Danish Experience Conclusions Denmark has initiated several national quality of care projects A strong collaboration between all important partners on the Danish Health care Scene Goals and actions are tied up in The National Strategy for Quality Improvement Quality improvement should be formalized and systematized in The National Model for Quality Improvement Denmark is waiting for the model. What should it be like?