Quality management in medicine

from Wikipedia, the free encyclopedia

In Germany, quality management in medicine includes, in accordance with Section 135a (2) No. 2 (formerly Section 136b (1) No. 1) SGB ​​V, as an institution-internal quality management system, all organizational measures that lead to an improvement in the processes in the medical institutions. A standard specifically for the healthcare sector, EN 15224 , has been published since the end of 2012 .

Demarcation

The concept of quality management in medicine must be differentiated from quality assurance in medicine . To this end, the Federal Joint Committee (G-BA) issued quality management guidelines in accordance with Section 135a (2) No. 2 SGB V and in accordance with Section 92 i. V. m. Section 137 (1) number 1 SGB V. This in turn reads from 2016 cross-sectoral quality management guidelines . Until the beginning of 1993, the term for quality management in the German-speaking area was " quality assurance ". Due to the international change in the meaning of this word, it has long been recommended in [DGQ11-04] not to use the word “quality assurance” to avoid confusion.

In this context, the terms management, safeguarding, monitoring, controlling and improving process quality are used side by side in German with fuzzy differentiation. Regular audits as a result of formal certification have not yet caught on in Germany.

In the international standard EN ISO 8402 the term "quality management" is defined as

"All activities of the overall management that define the quality policy, the goals and responsibilities within the framework of the quality management system and implement them through means such as quality planning, quality control, quality assurance / quality management presentation and quality improvement."

- EN ISO 8402

A central goal of quality management is to improve the quality of medical and nursing processes. They serve the needs-based and economical operation of health care facilities. The core of quality management is the internal systematic management of the service processes. In contrast, external quality monitoring is limited to retrospective analysis.

Differentiation from industry

Quality management in the healthcare sector is based on the rules of technology known from international standardization (e.g. according to ISO 9000 ). An essential difference to quality management measures in industry is that there is no mechanistic model for medicine that could justify a reliable measurement of process flows. Reliable measurement of the quality of results in medicine is also limited in comparison to industry, since there are no indisputable or generally valid indicators for measuring the success of treatment. In contrast to a standardized industrial product, the quality of treatment can only be assessed taking into account the individual affected.

Basic elements of quality management

The basic elements of quality management include:

  • the survey and evaluation of the current situation
  • the definition of goals
  • the description of processes and responsibilities
  • the training and guidance of all those involved
  • the implementation of change measures
  • the repeated survey of the current situation
  • internal feedback on the effectiveness of quality management measures.
  • the measures to improve patient safety
  • defining the minimum standards for risk management and error reporting systems

PDCA cycle

Continuous quality improvement through standardization

The PDCA cycle (Deming circle) describes an iterative four-phase problem-solving process. PDCA stands for the English plan - do - check - act , (German: plan - implement - check - act). The instruments of an institution's internal quality management, "definition of specific quality goals for the individual practice, taking implementation measures, systematic review of target achievement and, if necessary, adjustment of the measures" are supplemented by the technical term "PDCA cycle" to include the required systematics of the quality cycle with the widespread To clarify terminology. The PDCA cycle describes the phases in the continuous improvement process (CIP), which is the basis of all quality management systems.

CIRS

A Critical Incident Reporting System (CIRS) ( German  reporting system on critical events is) a reporting system for anonymous reporting of critical events ( English critical incident ) and near misses ( English near miss ) in institutions of health care . It originally comes from aviation . The following reporting systems are available:

Switzerland

  • CIRRNET - Critical Incident Reporting & Reacting NETwork

Austria

  • CIRSmedical Austria
  • CIRS of the Austrian Red Cross in the ambulance and ambulance service.

International

  • High 5s
  • PASQ European Union Network for Patient Safety and Quality of Care

Quality management in outpatient care

The contract doctors and psychotherapists are legally obliged to carry out quality management in their practices. How this is to be done is regulated by the guidelines on quality management of the Federal Joint Committee, which came into force at the beginning of 2006. One of the systems developed for general practitioners is Quality and Development in Practices (QEP). According to a survey by the Health Foundation in 2010, QEP was number one of the systems used by human physicians with a user share of 25 percent, and among psychotherapists even with a user share of 64 percent.

Basic elements

Patient care

  • Alignment of care with professional standards and guidelines according to the current state of scientific knowledge
  • Patient orientation, patient safety, patient participation, patient information and advice
  • Structuring of treatment processes

Practice management / employees / organization

  • Regulation of responsibilities
  • Employee orientation (e.g. occupational health and safety, advanced training, education and training)
  • Practice management z. B. Scheduling, data protection, escape plan
  • Hygiene management (including hygiene and skin protection plan),
  • Design of communication processes (internal / external) and information management including risk communication
  • Cooperation and management of the supply interfaces
  • Integration of existing quality assurance measures into internal quality management.

Sampling

For the year 2014, in accordance with § 8 of the ÄQM-RL, the implementation and development status of the facility's internal quality management (QM) in contracted doctor's practices and MVZ was surveyed for the 8th time. The self-reports of a sample of at least 2.5% of the resident doctors and psychotherapists were evaluated, whereby resident doctors and authorized doctors are integrated into the population. The survey was carried out using a nationwide questionnaire derived from the requirements of the ÄQM-RL.

Results of the 2014 sampling

Number of contract doctors N = 3,064 corresponding to 100%

planning not yet started 35 corresponding to 1.1%

Phase I - planning started 312 corresponding to 10.2%

Phase II - implementation started 462 corresponding to 15.1%

Phase III - started with review 166 corresponding to 5.4%

Phase IV - further development started in 2087, corresponding to 68.2%

External quality management of the German hospitals

Hospitals that are approved in accordance with Section 108 must report annual statistical data as part of external inpatient quality assurance. The legal basis for this are § 135a and § 137 of the Social Security Code V. The Federal Joint Committee is the central advisory and decision-making body. It converts the legal regulations into practical requirements for the hospitals. The guidelines adopted by it are binding for all doctors and hospitals. State offices for quality assurance in hospitals - organizationally affiliated to the respective state medical association or state hospital company - collect the data at state level and prepare evaluations for the hospitals. The independent AQUA Institute evaluates the data at the federal level. The goals of external quality assurance are to ensure an acceptable level of quality in patient care and more transparency of the quality and results of treatments. In order to achieve this, according to the specifications of the Federal Joint Committee (G-BA), comparable data are collected in all hospitals for selected operations and diagnoses, evaluated anonymously on the basis of defined quality criteria and sent back to the hospitals as a report every year. 30 operations and diagnoses are currently included in the external quality assurance (e.g. gallbladder removal and hip replacement).

The annual evaluation can be used to read off one's own quality level in comparison to the reference range set by federal specialist groups and the national average of the other hospitals. If there are significant deviations from the reference range, a so-called structured dialogue with individual hospitals or departments follows, ie the facilities concerned are asked for a written statement or asked to initiate specific improvement measures. The results of external quality assurance (e.g. complication rates) selected by the G-BA must also be published by the hospitals in an annual quality report.

Internal quality management of the German hospitals

Only a minority of German hospitals has so far (2012Q3) continuously recorded process data with the aim of concurrent (contemporary) quality management or risk management. There are no legal requirements beyond the dissemination of statistical data, so that no particular importance is attached to this approach. For the first time in 2011, the annual reports of the German Hospital Association (2009, 2010, 2011) only refer to the magazine Das Krankenhaus and the topics dealt with there.

Quality management of hospital hygiene in Germany

By replacing the outdated epidemic protection laws (up to 2000) and amending the Infection Protection Act (IfSG, from 2001) with the associated hospital hygiene regulations of the federal states, the appointment of a hygiene officer for each specialist clinic and a hygiene specialist for each clinic location is required.

In 2012, the Free Hanseatic City of Bremen was the last federal state to recognize the need to remedy deficits in quality management in hospital hygiene and to appoint a hygiene specialist.

Quality management in inpatient rehabilitation

In-patient medical rehabilitation facilities must have a certified quality management system (QMS) in accordance with Section 21 (3) SGB ​​IX so that they can be occupied by social service providers . Section 20 of Book IX of the Social Code stipulates that the different QM procedures must be accredited by the Federal Association for Rehabilitation eV (BAR).

Organizations

Medical Center for Quality in Medicine (AQuMed / ÄZQ)

The Medical Center for Quality in Medicine (German Agency for Quality in Medicine) (AQuMed / ÄZQ) is the joint competence center of the German Medical Association (BÄK) and the National Association of Statutory Health Insurance Physicians (KBV) for medical guidelines , patient information , patient safety , evidence-based medicine , quality indicators and medical Knowledge management . It was founded in 1995 and is based in Berlin.

ÄQuMed / ÄZQ has been developing a compendium Q_M_A for the introduction of practicable and proven quality management concepts in outpatient care, an internet, information and training program for quality management in outpatient care (QMA) since 2001.

Society for quality management in health care

The Society for Quality Management in Health Care (GQMG) is a specialist society for quality management in the facilities of the health system. Overcoming problems and further developing health care on the professional side is only possible with the involvement and cooperation of all professional groups involved.

The GQMG provides position papers and recommendations, such as

  • the GQMG position paper (2011) on process management in health care facilities
  • the GQMG position paper (2011) on quality managers in hospitals

Cooperation for Transparency and Quality in Health Care (KTQ)

The procedure of cooperation for transparency and quality in the health care system (KTQ) is an industry solution for the health care system. KTQ has been an independent legal entity as a GmbH since 2002. The KTQ has been in regular operation since mid-2002, and so far over 2000 facilities have been certified.

The development phase of the KTQ certification procedure for hospitals ran from 1997 to 2002 and was funded by the Federal Ministry of Health (Germany) and scientifically supported by the Institute for Medical Information Processing in Tübingen.

Institute for Quality Management in Health Care (IQMG)

The Institute for Quality Management in Health Care (IQMG) has set itself the task of developing quality management instruments for the health sector. Initially, the Integrated Quality Management Program Rehabilitation ( IQMP Rehabilitation) was developed in collaboration with Werner Müller-Fahrnow (Charité Universitätsmedizin Berlin). This has been available to the rehabilitation facilities since March 2004. A comparable quality management program for acute clinics does not yet exist.

Institute for Quality and Efficiency in Health Care (IQWiG)

As an independent scientific institute, IQWiG examines the benefits and harms of medical measures for patients. Scientific reports and generally understandable health information provide information on the advantages and disadvantages of examination and treatment procedures.

Other quality institutions in health care

Numerous institutions and organizations in Germany deal with quality management in medicine and health care.

See also

swell

Web links

literature

  • German Society for Quality (Ed.): Quality management in social services . Beltz Juventa, Weinheim; Basel 2016, ISBN 978-3-7799-2355-8 .

Individual evidence

  1. ↑ German Society for Quality e. V .: Terms for quality management (= German Society for Quality: DGQ-Schrift. No. 11-04). Newly edited by the DGQ Steering Committee for Joint Work (LAG). 6th edition. Beuth, Berlin 1995, ISBN 3-410-32860-2 .
  2. ↑ Glossary of terms and concepts in quality management .
  3. ↑ Change to the quality management guideline in statutory health care . Implementation of § 137 Paragraph 1d Clause 1 SGB V, resolution of the Federal Joint Committee of January 23, 2014. Accessed on May 25, 2016.
  4. ^ Deming, WE: Out of the Crisis . Massachusetts Institute of Technology, Cambridge 1982, ISBN 0-911379-01-0 , p. 88.
  5. ↑ Change to the quality management guideline for statutory health care . Basic reasons for the draft resolution of the Federal Joint Committee on the implementation of Section 137 (1d) sentence 1 SGB V of January 23, 2014. Accessed on May 25, 2016.
  6. ↑ CIRSmedical . Retrieved May 25, 2016.
  7. ↑ CIRS-AINS . Retrieved May 25, 2016.
  8. ↑ CIRSdent . Retrieved May 25, 2016.
  9. ↑ KH-CIRS . Retrieved May 25, 2016.
  10. ↑ PaSIS . Retrieved May 26, 2016.
  11. ↑ CIRSmedical WL . Retrieved May 26, 2016.
  12. ^ Network CIRS-Berlin . Retrieved May 26, 2016.
  13. ↑ CIRS on preclinical emergency medicine , accessed on May 26, 2016.
  14. ↑ CIRS Pediatrics . Retrieved May 26, 2016.
  15. ↑ Error reporting and learning system for general practitioners , accessed on May 26, 2016.
  16. ↑ Error reporting system of the KDA for geriatric care ( Memento of the original from April 10, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Retrieved May 26, 2016. @1@ 2Template: Webachiv / IABot / www.kritische-ereignisse.de
  17. ↑ CIRS of the statutory accident insurance in the fire service . Retrieved May 26, 2016.
  18. ↑ CIRS rescue  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. . Retrieved May 26, 2016.@1@ 2Template: Dead Link / www.cirs-rescue  
  19. ↑ CIRS Bavaria . Retrieved May 26, 2016.
  20. ↑ CIRS-Palliativ ( Memento of the original from January 11, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Retrieved May 26, 2016. @1@ 2Template: Webachiv / IABot / www.cirs-palliativ.de
  21. ^ CIRS MSP . Retrieved May 26, 2016.
  22. ↑ CIRS urology. Retrieved May 26, 2016.
  23. ↑ CIRRNET - Critical Incident Reporting & Reacting NETwork (CH) . Retrieved May 26, 2016.
  24. ↑ CIRSmedical Austria . Retrieved May 26, 2016.
  25. ↑ CIRS of the Austrian Red Cross . Retrieved May 26, 2016.
  26. ^ High 5s Project
  27. ^ European Union Network for Patient Safety and Quality of Care . Retrieved May 26, 2016.
  28. ↑ a b Quality management guideline for statutory health care - Federal Joint Committee. In: www.g-ba.de. Retrieved October 21, 2016 .
  29. ^ Information from the KBV on QEP
  30. ↑ Quality management and patient safety in medical practice 2010 , study by the Health Foundation carried out by the Society for Health Market Analysis. Retrieved May 26, 2016.
  31. ↑ Reporting by the Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Physicians in accordance with the Quality Management Guideline for Contractual Medical Care (ÄQM-RL). Retrieved October 21, 2016 .
  32. ↑ Structured dialogue for the 2018 EY . Bavarian Working Group for Quality Assurance in Inpatient Care (BAQ), accessed on July 10, 2019 .
  33. ↑ QMA
  34. ↑ GQMG position paper on process management (PDF; 291 kB).
  35. ↑ GQMG position paper quality manager (PDF; 300 kB).