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Johan C. Kips, MD, PhD,

CEO

Approach to quality management at theUniversity Hospitals Leuven (UZ Leuven), Belgium

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Hospital quality management

Characteristics of high quality care :

- safe

- effective

- patient-oriented

- timely

- efficient

- equitable

Crossing the quality chasm, Institute of Medicine 2001

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Hospital quality management

Value creation =

Result

(quality improvement)

Cost

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Quality management at UZ Leuven

UZL in Belgian health care

Quality management at UZ Leuven :

- strategic options

- management tools

- benchmarking

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Belgium

Flemish Region : 6 mio inhabitants

12.211 km2

Dutch speaking

Belgium : 10.5 mio inhabitants

30.528 km2 (~ Maryland)Federated union of Flemish, Brussels

and Walloon Region

Brussels Leuven

Flemish Region : 6 mio inhabitants

12.211 km2

Dutch speaking

Belgium : 10.5 mio inhabitants

30.528 km2 (~ Maryland)Federated union of Flemish, Brussels

and Walloon Region

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Gasthuisberg - Health Sciences Campus

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Profile of acute hospitals in Belgium

Hospitals number beds admissions

Small (< 500 b)

79

(74 %)

23.420

(54 %)

1.128.456

(55 %)

Large (> 500 b)20

(19 %)

13.583

(31.3 %)

647.192

(31.5 %)

AMC

7

(7 %)

6.379

(14.7 %)

278.124

(13.5 %)

Belgium 106 43.382 2.053.772

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Positioning UZ Leuven

Hospital Number of beds

UZ Leuven 1955

Karolinska Stockholm, Sweden 1700

Oxford Radcliffe Hospital Trust, UK 1400

LUMC Leiden, the Netherlands 800

Average hospital Flanders 445

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Broad accessibility to care : abundant offer

No gatekeeping / echelons : freedom of choice for the patient

Fee-for-service payment, based on extensive tariff list

=> high patient satisfactionno waiting lists

percieved good quality (no formal quality control)

Extensive coverage through compulsory health insurance

system=> low unit cost, high throughput volume

high degree of equity

Organisation of health care in Belgium

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Organisation of hospital care in Belgium

Dual organisation :

- not-for-profit institutions (majority private)

- self employed physicians

participation in hospital management within legal

framework

Dual financing :

- hospital activities : pathology linked

(APR-DRG based case-mix) within closed budget (40 %)

- medical activities : fee-for-service (40 %)

co-financing of hospital activities within legal framework

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Federal competence : curative care

social security based compulsory health insurance system

legal framework on health care providers and provisions

including hospitals

defines minimally required (mainly structural) qualitystandards for hospitals

Legislation on health care in Belgium

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Regional competences :

preventive care

responsibility with regard to hospitals :

- co-funding hospital infrastructure- audit of federal quality standards

can (and does) add additional requirements : presence of

CQI program based on self evaluation

As yet, no formal accreditation process required

No legal obligation on public reporting of outcome data

Legislation on health care in Belgium

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Quality management at UZ Leuven

UZL in Belgian health care

Quality management at UZ Leuven :

- strategic options

- management tools

- benchmarking

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Mission UZ Leuven

Leading European Academic Health Services System

Strategy UZ Leuven 2009 - 2014

Added value creation

innovative care / quality improvement

Integrated approach hospital / university

translational research

Networking

planning with gps, regional hospitals, elderly care units

Recruitment and retention of human capitaltop employer award

Organisational efficiency

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Department specific ISO and other accreditations

JACIE-accreditation : hematology department

BFHI - Baby friendly hospital (UNICEF WHO)

ISO-Certificate:

Medical laboratory, center for molecular diagnostics Laboratory for clinical genetics

Fertility center

Nuclear medicine

Pharmacy

Center for forensic medicine FAVV Smiley (Federal Agency for safety of foodchain)

AnySurfer quality label for external website www.uzleuven.be

http://www.uzleuven.be/http://www.uzleuven.be/

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Added value creation as strategic option

Continuous improvement of quality and expertise availablewithin UZL :

Compliance with international standards on hospital widequality and patient safety

=> accreditation by the Joint Commission International (JCI)

Definition of disease specific standards of quality of care

=> designing care programs within UZL

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Care programme centered organisation structure

Clin dept. Clin dept. Clin dept.

CP committee : 8 clinical dept. heads

Operationalmanagement

Medical managementExecCom

Aim of care programs is to optimise :- quality of patient care- patient safety

Quality of :-patient/staff orientation-financial performance

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UZL care programs

Homogenouspatientgroup

Therapeutic module 1

Diagnostische Module 1

Rehab module 1

Follow up Module 1

Qualityoutcome

ACs

Diagnostic module

Therapeutic module

Rehabilitation module

Follow up module

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Care programs : linking outcome to cost

160

161

162

163165

166

167

168169

170171

172

173174

175

176

177178

179

180

-5,0

-4,0

-3,0

-2,0

-1,0

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

10,0

-5,0 -4,0 -3,0 -2,0 -1,0 0,0 1,0 2,0 3,0 4,0 5,0

Cardiovascular care programs

implant defib

cardiac valve surgery

Input

Income

PCI

CABG

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Care programs : linking outcome to cost

Labeling in HIS- Identifying/following patient track throughout care process- Administrative optimalisation (eg diagnostic work up,)- Link with clinical paths (eg nursing plan,)

Process optimalisation- Shortened length of stay- Reduced waiting times- Rational medication use

Pathology oriented communication system- Internally : defined uniform care process (teaching aspect)- Externally : guide for referral to dedicated staff member

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Quality management at UZ Leuven

UZL in Belgian health care

Quality management at UZ Leuven :

- strategic options

- management tools

- benchmarking

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EFQM model for integrated quality management

Improvement andinnovation

Leadership

Peoplemgt

Staffappreciation

Patientappreciation

Societyappreciation

Resourcesmgt

(Care)process

mgt

Key resultsand

transparency

Organisation Results

Strategy

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Quality management outcome measures

Improvement and innovation

People :AbsentesmAccidents

Mutations/efflux

Patints :Waiting times

P-iMSCPOE drug/drug interactions

Society :Q in yearly report

CertificationsAccreditation

Key results

Nosocomialinfectiions

(MRSA, C. diff,)

Transfusion reactions

Decubitus

HSMR

Results

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aim :deliveryof high

quality care

public accountability

measurements

PDCA cycle

improvement

CQI process

- internal follow up- external benchmarking

Quality Management : overall aim

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Quality balanced scorecard

Combines non-clinical and clinical process / outcomeindicators

- collected centrally (eg overall in hospital mortality) or at

department level (eg CABG mortality)- in hospital follow up and external benchmark when available

(databases provided by federal administration or commercial

initiatives)

To be complemented by data from the Flemish Hospitalnetwork K.U.Leuven

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Flemish Hospital network K.U.Leuven

DamiaanOostende

Groeninge

Kortrijk

Sint-Lucas

Brugge

AZ Turnhout

ImeldaBonheiden

Jessa Ziekenhuis

ZOL

Genk

UZ Leuven

MariaziekenhuisOverpelt

Sint-TrudoSint-Truiden

Zusters van BarmhartigheidRonse

Sint-FranciskusHeusden Zolder

Sint-Blasius

Dendermonde

O.L.VrouwziekenhuisAalst

AZ Sint-MaartenMechelen

Sint-ElisabethHerentals

Maas en KempenMaaseik

AZ Diest

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Flemish Hospital network K.U.Leuven

CQI programme

Scope of indicators :

- Clinical (medical and nursing) performance and patient safety

- Patient orientation

- Human resource management- Financial performance

Aim :

- Benchmarking to support internal quality improvement initiatives

- Identification of best practices to improve efficiency

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Approach to quality management

Conclusions Aim is to provide added value

outcome as primary objective

Importance of CQI culture within hospital- involving all departments

- appealing to willingness to provide care

Need for / use of valid data- benchmarking with trusted partners