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8/7/2019 Johan Kips
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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/8/7/2019 Johan Kips
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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
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-5,0
-4,0
-3,0
-2,0
-1,0
0,0
1,0
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-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
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