Dr. Christof VeitBQS Institut for Quality and Patient SafetyDusseldorf / Hamburg

Quality and Regulation.Experiences from the German Health Care System.

London, 14th February 2013

Solidarity is a core social value in European culture.

Good quality Health Care for each citizen is a central part of our European societies.

Self Government

Ministry of Health:

Framework for the Health Care System

Self Government:

Joint Federal Committee

Sickness FundsHospitalsPracticesPatients

Services.Prices.Quality.

Self Government

Regulation of Quality

Regulation of Care

Regulation of Quality Management

Self Government

Regulation of Quality

Regulation of Care

StructureProcessCase volume

Self Government

Regulation of Quality

Regulation of Quality Management

Quality Management

National mandatory benchmarking

Public reporting

Sample testing

Measurement areas: 30

Quality indicators: 289 (88% risk adjusted)

Data sets: 3.600 Million 96.6%

Hospitals: 1,605 98.2%

Data validity: good (different validation procedures)

Results: ranging from „requires national level intervention“ to „excellent“

National Mandatory Benchmarking

Benchmarking: Projects.

>30 Projects on the National Level:

Hip- and Knee ReplacementCholecystectomy Gynaecological OperationsBreast Cancer OperationsObstetricsCardiac Pace MakersCoronary CathetersHeart SurgeryDecubital UlcersCommunity acquired PneumoniaTransplants .......and others

Admission Discharge

Indication Process(short term)(long term)

20% 20% 60%

Distribution of quality indicators

Outcome

Hospital Care

National Mandatory Benchmarking

Nat. Institute

Experts

1,708 Hospitals in 16 States

project offices

ProjectOffice

Experts

National Benchmarking

ProjectOffice

Experts

numerical outliers

Structured Dialog

ProjectOffice

Experts

qualitative outliers

Correct!Check!

Steering Committee

National Committeeand National Experts

Structured Report

ProjectOffice

Experts

regional meetings

Regional Learning.

Self Government

Regulation and Culture

Self Government

Patient involvement.

Quality Improvement starts with a narcistic wound:I am not as brilliant as I would love to believe.

And besides of 1000 excuses: I could have done better.

I do better.

personal responsibility and system design

Quality is team work.

Sharing, networking institutions instead of castles.

Self Government

Pay for Performance?

P4P Modell

Self Government

You cannot replace primary motivation with financial incentives.

Pay for Performance

Quality of health care is guaranteed by primary motivation.

Pay for Performance

There also are limits to sanctions.

Quality and Market.

Market lives from differences.

Trust comes from equal quality of care at all places.

Quality improvement is about lowering variation towards better care.

Good quality care + Patient’s choice.

But: market mechanisms also want to differentiate access to care.

Prime offers for a smaller number of wealthy patients.

Solidarity?

We call it: the freedom of the free fox in the free hen house.

Quality rule:

Work with motivation

but without pain no change.

Self Government

Quality: Regulation and Culture

Quality

www.bqs.de