Hospital quality reports

EH: You believe that quality management should be an integral part of a hospital’s workflow, not just an additional service. Would you explain your ideas? 
MS: Quality management should always have a joint ‘bottom up and top down’ approach - that is, not simply imposed from above but experienced and managed on the frontline. It is not viable to address quality management issues in wards or departments, with hospital or company managers showing little interest. They depend on each other. Therefore, training and resources should be made available for those working in the departments, so that they can establish quality management activities and find and develop solutions for quality assurance. Individuals with the right know-how, who develop and implement improvement processes, and who can solve problems, must also provide adequate support.

EH: But departments and wards are usually under-staffed - does this mean more people should be employed to improve quality of care?
MS: Yes, that’s the big problem - not enough staff! Of course it would be nice to have more. However, until we can afford it we must make do with the level we have. On the other hand, we have to develop self-criticism and admit that certain issues can be improved simply by better work organisation. Hospitals are quite sluggish when it comes to making changes. Recently, we’ve made some quite surprising improvements simply by changing certain workflow processes. Initially, both doctors and nurses expressed doubts about our ideas. However, by demonstrating issues with encouraging examples we could show how beneficial and timesaving certain changes to individual workflow can be. So now our available resources are used far more efficiently, which, in turn, gives more satisfaction to employees.

EH: Patients also profit from this, and will talk about positive experiences.
MS: That’s our intention. Modern hospitals are service-orientated. Patients have a right to expect processes to be centred on their needs.

EH: As a patient, how do I find a good hospital? Is there a hospital ‘seal of quality’?
MS: There are various accreditation concepts for hospitals. Audits are carried out by licensed independent organisations, which then issue one of the three types of certificate externally. Some are certified by the ISO. Also, there’s the European Foundation For Quality Management (EFQM), and the Co-operation of Transparency and Quality (KTQ) - a self-evaluation tool which uses ‘visitors’ who are healthcare experts trained to write reports on hospitals, on which the accreditation is then based. Hospitals can add the accreditation to letterheads so patients know they are taking the certification issue seriously.
That’s one way. However, according to current Social Welfare Legislation V guidelines, there is another way. For 2004, all licensed hospitals will have to write up quality reports. We have done this since 1995 in Marburg. The quality report contains information - accessible for patients - on how many operations of a certain kind were carried out at the hospital, or how many types of illness were treated at the hospital. There will also be data about the degree of complications experienced by patients in the hospital. We think this is a good thing - if the figures are correct.

EH: That can be the problem with statistics.
MS:  Which brings us to the next problem. If quality and competition are so important politicians will argue that there must be spot checks. Many countries have done this for a long time and I think we in Germany will follow soon. This will be a good thing, otherwise those who are honest and up-front with their facts and figures - for example about numbers of complications - will lose out to hospitals that are vague about their statistics and do not admit to problems.

01.07.2003