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Adapting the ISO series -Adapting the ISO series -

experiences with qualityexperiences with quality

management in Jellinek Centre,management in Jellinek Centre,

The NetherlandsThe Netherlands

Ineke Kosse,Ineke Kosse,

Jellinek Centre, AmsterdamJellinek Centre, Amsterdam

““Quality Management in the Public Sector”Quality Management in the Public Sector”Vilnius 27-28 March 2006Vilnius 27-28 March 2006

Agenda

1. What is Jellinek?

2. Quality projects in Jellinek

3. HKZ / ISO approach

4. Benefits of a quality management system

5. Where is the end?

1. What is Jellinek?

Addiction Centre

Mission: The Jellinek Center is a dedicated, innovative and leading

organization for prevention, cure and care of persons with addiction problems and related high-risk life-styles.

History: Founded 1909 for alcohol problems, since 1970 also dealing with

drugs, since 1990 dealing with various addictionsResources:

600 personnel, budgets 30 million Euro a year, 7 locationsOrganization:

Non-profit foundation with 3 divisions Patients:

Annual caseload - 3500 in the region of Amsterdam

Organisation structure

Directorate

Circuit Complexe Zorg

Personnel department

Financial department

Electronic data processing departmetn

Technical department

Circuit Intensieve behandeling

Medical registration department

Circuit Aanmelding

Reclassering & Activering

Ta

nd

he

elk

un

de

CODA

Detox

Complexe Intramurale Zorg

Mentorenteam

Jellinek Outreachend TeamKlinische behandeling

Dagbehandeling

Gooi & Vechtstreek

Nieuwe Skuul

Intercultureel Motivatie Centrum

Ambulante Behandeling

Aanmelding

Cliënten Service Desk

Justitiële Verslavingszorg

Educatieve Maatregel Alcohol- & Verkeer

Werk & Scholing

Cliëntenraad

Ondernemingsraad

La

bo

rato

rium

Dubbele Diagnose

Communications

Adviseur Raad van Bestuur

Quality & Innovation

Secretariaat Raad van Bestuur

Ambulante Detox

Pre

ve

ntie

Verslaving & Psychose

Disease management in addiction care[Skinner, 1988]

No use of substance

Chronically addicted

Risk full use of substance with complaints

AddictedRisk full use of substance

experimental use of substance

Use of substance without

complaints

Alcohol problems

Drug problems

Smoking problems

Gambling problems

Eating problems

Annual statistics

13 094 treatment episodes4 164 clients - 76% male, 24% female,

30% employed, 73% Dutch DSM IV 59% Axis I problems, 25% Axis II problems

Substances

1955

559

92

88

512

1365

2389

Other

Gambling

Medicine

Smoking

CannabisCocaine

Heroin

Alcohol

5%5%

1%1%

5%18%

21%44%

interventionswithout lodging/stay

interventions withday (night) lodging/stayin

take

/ r

efe

rral E

valu

atio

n

deto

x

Proactive case management and time out

interventions with 24-hourslodging/stay

shortintervention

SelfhelpAfter carePrevention

Treatment overview

internet

Treatment services

Prevention Campaigns, training, counselling, advice, epidemiology

survey, unity peer project Intake

Standard assessment, planning and coordination, probation, follow-up

Intensive Cure Outpatient detox, motivational interviewing, relapse

prevention, life style training, counselling for doctors Intensive Care

Crisis intervention, in-patient detox, double diagnoses, methadon programmes, culture-specific care, sheltered housing, day support, work programs, case management, counselling for social services

Dentistry and Clinical Lab

Question:

Who are your clients?

Stakeholders

Raad van Bestuur

Circuit ComplexeZorg

Personeel &Organisatie

Economische &Adminitratieve

Dienst

Automatisering &Informatie

Facilitaire Dienst

Circuit Intensievebehandeling

Zorgadministratie

CircuitAanmelding

Reclassering &Activering

Tandheelkunde

CODA

Detox

Complexe Intramurale Zorg

Mentorenteam

Jellinek Outreachend TeamKlinische behandeling

Dagbehandeling

Gooi & Vechtstreek

Nieuwe Skuul

Intercultureel Motivatie Centrum

Ambulante Behandeling

Aanmelding

Cliënten Service Desk

Justitiële Verslavingszorg

Educatieve Maatregel Alcohol- & Verkeer

Werk & Scholing

Cliëntenraad

Ondernemingsraad

Laboratorium

Dubbele Diagnose

& Communicatiemedewerker

Adviseur Raad vanBestuur

Kwaliteit &Innovatie

Secretariaat Raadvan Bestuur

Ambulante DetoxP

reventieVerslaving & Psychose

ClientsSocial

Network

Government

Financing organisations

GG&GD

Housing companies

Hospitals

Schools

Police

Doctors

Consultancy

Lawers

Accountants

Employment servicesCleaning

companies

Linen suppliers

Pharmacy Food suppliers

Travel agency

Supply chain

Partners

Externalcustomers

Suppliers

Management

EmployeesInternalClients

Citizens

Media

Neighbourhood

Local politiciens

Actors

Quality projects in Jellinek

START

Quality projects in Jellinek

Quality projects in Jellinek Ups and downs in Quality Management

Best in Class

1988 1991 1992 1993 1994 1995 1996 1997 1998 1999 200019901989

Leidschendam 1 Leidschendam 2 & KwaliteitswetLeidschendam 3

Resultaten Scoren

Kick-off

Beach Hotel

EFQM/INKModel

Adaptation Problems

EFQM/INK Assessment

Action Plan Indicator System

Dutch INK Quality Prize

ISO Project

ISOCertificate

Change Organisation

Structure

ImprovementProjects

Quality manager

Getting Lost

ResistanceThe Zoo

EnergyProblems

EFQM Ass.

2001 2002 2003

PerformanceManagement

EFQM Assessment

RelocateBPR

(new) ISOCertificate

ImplementationProblems BPR

Department Q&I

2004 2005 2006

Relocate

HKZcertificat

ion

ECD

Quality projects in Jellinek Improvement projects

Shadowing

Project “Letters”

Jellinek News

Informatics

Relapse prevention

Pharmacotherapy

Part-time treatment

Quality projects in Jellinek EFQM 1994 and 1996

1A Betrokkenheid leiding (53%) [60%]

1B Kwaliteitscultuur (58%) [70%]

1C Erkenning, waardering (45%) [50%]

1D Ondersteuning (40%) [60%]

2A Kwaliteitsmanagement (65%) [70%]

2B Informatie (65%) [80%]

2C Bedrijfsplannen (55%) [60%]

2D Communicatie (60%) [50%]

2E Toetsing (40%) [50%]

3A Personeelsbeleid (35%) [50%]

3B Deskundigheid (25%) [50%]

3C Totstandkoming van doelen (58%) [60%]

3D Betrokkenheid bij verbet. (20%) [60%]

4A Financiën (43%) [60%]

4B Informatievoorziening (65%) [50%]

4C Leveranciers (25%) [40%]

4D Technologie (45%) [30%]

5A Identificatie van processen (38%) [50%]

5B Besturing, beheersing (30%) [50%]

5C Doorlichting, verbetering (20%) [50%]

5D Stimuleren van innovatie (23%) [50%]

5E Procesverandering (15%) [50%]

2.BELEID ENSTRATEGIE

(57%) [62%]

3.PERSONEELS

MANAGEMENT(34%) [55%]

4.MIDDELEN

MANAGEMENT(44%) [45%]

1.LEIDERSCHAP(49%) [60%]

5.MANAGEMENTPROCESSEN(25%) [50%]

AANDACHTS-GEBIEDEN

DEELASPECTENFASE

IFASE

IIFASE

IIIFASE

IVFASE

V

40%20% 60% 80%

ORGANISATIE-GEORIENTEERDE AANDACHTSGEBIEDEN

1994 1996

II

III

IV

V

I

Personnelsatisfaction

Processes

Resources

Personnelmanagement

Policy and strategy

Leadership

Customer satisfaction

Impact on society

Results

20%

40%

60%

80%

Quality projects in Jellinek Improving Processes

Long preparation

Flowcharts for teams

Handbook for teams

New project leader

Certification audit

Internal audits

In January 1999 the Minister of Health handed over the ISO certificate to the Jellinek

Quality projects in Jellinek absence through sickness

Ziekverzuim en meldingen

1,31%

4,7%

6,1%

6,8%

1,98%1,86%

0%

1%

2%

3%

4%

5%

6%

7%

8%

2002 2003 2004

Ziekte verzuim Meldingsfrequentie

And running further…

Explanation of the HKZ model

HKZ model

HKZ modelDeveloped by:

PatientsHealth

insurance companies

Health careorganisations

HKZ model

Containing quality aspects from:

The National organisation for mental health (GGZ)

Professionals working in the mental health sector

Health insurance companies

Patient organisations

Legislative and regulatory requirements

HKZ model

Benefits in comparison with ISO 9000:

Primary process is central

Requirements are integrated in the primary process

Harmonisation in the mental health care supply chain

Educate knowledge professionals

Containing specific legislative and regulatory for the mental health care

HKZ Model

1Intake

3Evaluation

2Treatment

8services by

third parties

5Personnel

4policy &

organisation9

documents

6R & D7

Environment

HKZ ModelExample intake process

Traject-toewijzing

Beslissing 1

IntakeEuropASI, lab,

thorax, medischeobservatie

Aanvullend

onderzoekdiverse consulten,

"casuistiek", detox

EindeAdviesgesprek

Beslissing 2

Indicatie-stelling

EindeMin. Interv.

Behandel-overeenkomst

AanmeldingTraject-

evaluatieBehandeling

of Zorg

HKZ Model

Question about complaints

HKZ ModelHKZ requirements about Complaints

1.19 Patients are given the complaints procedure

1.4.6 Organisational capacity to handle complaints

3.5 Handle complaint according to procedures

4. Agreement with patients organisations about complaints procedure

4.20 Complaints Commission

5.5 Complaints from personnel

Benefits of HKZ

What are the benefits of having a certified quality system?

Benefits of HKZ

Processes are clear

Responsibilities

Transparency

To demonstrate quality to second parties

But is certification the end …?

… or the starting point to becoming the best?

Conclusion

15 years of practice in Quality Management shows ups and downs … but a positive trend

Consistency in leadership, e.g. quality budget in 2003 >2%

Integral Quality Policy is needed, not just one strategy (EFQM assessment combined with ISO process management, evidence based treatment and learning based on outcomes)

Self assessment (Plan-Do-Check-Act) was/is an important tool for (creating) an organization culture where quality improvement is embedded in professional-based practice.

Future

Maintain Integral Quality Policy

Further improvements in performance management

Further use of Technologies

Further use of the following ‘rich resources’ [Berwick, 2002] Clients, families and communities The life experience of the health care workforce Knowledge from the variation among us Global brains

Ačiū Thank you

ikosse@jellinek.nl