Séance académique - Academische zitting

Collèges de Médecins - Colleges van Geneesheren

Feedback en perspectieven

Feed-back et perspectives

Introduction – Introductie

A. Perissino

M. Haelterman

Introduction

Origin of Colleges of Physicians Methodology for quality improvement

Origins

In 1999, following the advice of the National Council for Hospitals, the Belgian Government created the Colleges of Physicians, in order to - evaluate the activity (in their specific field)- promote quality of care - orient health policy

Nine colleges started their activities in 2000:In Vitro Fertilization, Emergency care, Intensive care, Dialysis, Geriatrics, Neonatal Intensive care, Radiotherapy, MRI and Cardiology

Oncology and Medical Imagery started their activities in 2004

Methodology

THE PRINCIPLES leading the setting up of the Colleges are :

legitimacy expertise representativeness without coercion for the participating hospitals

(even if registration is mandatory)

The activity of the Colleges is based upon the quality cycle

Plan – Do – Check - Act

Although there are some variations from one college to another, the main steps are :

0) to set up and define the organization of the Colleges

1) to define a strategy and to choose a theme

2) to define quality indicators to compare resources, processes and output

in Belgian hospitals

3) to provide feed back, recommendations and guidelines for the field

4a) to promote improvement of quality and to change the management of the

patient’s care in hospital units

4b) to report to the decision makers

Hospitals

DODO

Collèges

1. Vision, Mission,Priorisation

2. Objectives, Data collection, Assessment

3. Diagnosis Feedback Guidelines Recommendations

4. Local or national Action

Colleges Hospitals

Local level : ad hoc correctionLocal level : ad hoc correction quality improvement, process reengineering, …quality improvement, process reengineering, …

National level : structural changeNational level : structural changereimbursment, organisation, equipment, manpowerreimbursment, organisation, equipment, manpower , …., ….

Texte

Texte

CHECKACT

PLAN

Quality cycles

DO

Frequency

Quality +Time

Recalcitrant 16 %

Late Majority

34 %

Early Majority

34 %Precursors

16 %

Quality improvement

Colleges of Physicians

Patients

Other Health workers

Medical doctors

Decisionmakers

Stake-holders

Quality cycle

• Input

• Processes

• Output

LOCALLOCAL

HH

EE

AA

LL

TT

HH

POLICYPOLICY

AA

CC

TT

II

OO

NN

Similarities with peer-review

The Colleges of Physicians • are easily accepted by peers• influence positively professional behaviours by

education rather than by repression.

Reviews, benchmark and feedback of the data stimulate physicians to reconsider their practices.

Global quality improvement further catalyzes positive outliers for progression.

Differences with peer-review

First particularity : the Colleges of physicians are supported by authorities and decision-makers.

Second particularity : the Colleges give the opportunity for broader local or nation-wide impact of inter- and multidisciplinary studies.

Third particularity : recommendations of the Colleges are taken into account by health decision-makers to improve health policy.