ELEMENTS FOR QUALITY MANAGEMENT IMPLEMENTATION IN PRIMARY HEALTH CARE

1. ELEMENTS FOR QUALITY MANAGEMENT IMPLEMENTATION IN PRIMARY HEALTH CARE Pedro J. Saturno Profesor de Salud Pública,Universidad de Murcia, España Visiting Lecturer in Quality Management, Harvard School of Public Health, USA European Health Forum, Gastein, September 2002 Universidad de Murcia, España

2. ELEMENTS FOR QUALITY MANAGEMENTE IMPLEMENTATION IN PRIMARY HEALTH CARE I . LEADERSHIP II. TRAINING III . INCENTIVES IV . MANAGEMENT OF CHANGE V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY MANAGEMENT

3. I. LEADERSHIP • Key activities: to influence, to guide. • Emphasis in intangible elements (mission, values, motivation). • Its target objective is people. “Good managers know how to do things; good leaders know what things should be done”.”

4. II. TRAINING • Effective • Whithin appropriate context • Efficient  Problem-Solving-oriented  Fully adapted to Health  Distance learning, guided in-service self-learning

5. III. INCENTIVES • Intrinsic unlimited and with permanent effect • Extrinsic limited and with short time effect

8. IV. MANAGEMENT OF CHANGE • Intentionally planed and performed • Defined strategy • Defined structure for QM • Comprehensive vision for QM activities • Resources

9. IV. MANAGEMENT OF CHANGE • Intentionally planed and performed • Defined strategy • Defined structure for QM • Comprehensive vision for QM activities • Resources

10. HEALTH SYSTEM QUALITY INFORMATION SUPERVISION/INFORMATION QUALITY OF A HEALTH CARE INSTITUTION/CENTRE SUPERVISION/INFORMATION INFORMATION QUALITY OF INDIVIDUAL HEALTH CARE Quality management through the health care system CHARACTERISTICS AND RESPONSABILITIES SYSTEM LEVELS FOR QUALITY • Population-based indicators, including all dimensions of quality and all institutions. • Focus on overall system strategies. • Responsibility of high level managers and political authorities. • Indicators on the quality of the specific services for the specific population served by the institution. • Focus on optimizing resources and regulating processes Indicators on the quality of the organization. • Responsibilty of the managers of the institution • Indicators on satisfaction, technical quality and effectiveness for specific conditions and type of patients. • Focus on clinical quality on a broad sense. • Responsibility mostly of clinical personnel.

11. IV. MANAGEMENT OF CHANGE • Intentionally planed and performed • Defined strategy • Defined structure for QM • Comprehensive vision for QM activities • Resources

12. GROUPS OF ACTIVITIES FOR QUALITY IMPROVEMENT QUALITY IMPROVEMENT CYCLES MONITORING QUALITY PLANNING OR DESIGN

13. IV. MANAGEMENT OF CHANGE • Intentionally planed and performed • Defined strategy • Defined structure for QM • Comprehensive vision for QM activities • Resources

14. V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY MANAGEMENT • A PERSONAL HISTORIC PERSPECTIVE: “from preaching to criticising” • THREE FHASES: • Convincing first-line caregivers (Iberian Program) • Facilitating implementation (EMCA Program). • Challenging managers (the real challenge for quality) • ...... AND A SUMMARY STATEMENT:

15. “ Theory without practice is armless. Practice without theory is blind” Leonardo da Vinci

16. METHODS FOR QUALITY OF CARE EVALUATION.: Myths, traps and tricks (1991) * The myth of global quality, the trap of listings. * The myth of evaluating results, the trap of apparent validity. * The myth of the brilliant method, the trap of the lack of feasibility.

17. Myths, traps, and tricks (2002) 1. The myth of the “models”(EFQM, JCAHO, ISO…) 2. The myth of control: monitoring without appropriate methologogy. 3. The (in practice) myth of total quality management. 4. Management by processes: the new vision. 5. The never-ending terminology traps. 6. The myth of leadership

18. HEALTH SYSTEM QUALITY INFORMATION SUPERVISION/INFORMATION QUALITY OF A HEALTH CARE INSTITUTION/CENTRE SUPERVISION/INFORMATION INFORMATION QUALITY OF INDIVIDUAL HEALTH CARE Quality management through the health care system CHARACTERISTICS AND RESPONSABILITIES SYSTEM LEVELS FOR QUALITY • Population-based indicators, including all dimensions of quality and all institutions. • Focus on overall system strategies. • Responsibility of high level managers and political authorities. • Indicators on the quality of the specific services for the specific population served by the institution. • Focus on optimizing resources and regulating processes Indicators on the quality of the organization. • Responsibilty of the managers of the institution • Indicators on satisfaction, technical quality and effectiveness for specific conditions and type of patients. • Focus on clinical quality on a broad sense. • Responsibility mostly of clinical personnel. • Indicadores de satisfacción, calidad científico-técnica y efectividad en tipos concretos de pacientes. • Enfocados a la calidad de la atención clínica en sentido amplio • Responsabilidad principalmente del personal que provee directamente los servicios

19. 4. MANAGING BY PROCESSES: • A NEW VISION FOR HEALTH CARE ORGANIZATIONS. • “EMPOWERMENT”. • A DIFFERENT CONCEPT OF PROCESS.

20. MANAGING BY PROCESSES: AN ORGANIZATIONAL VISION A FIGURE SHOWING THE CHANGE TO A FOCUS ON PROCESSES Before focusing on processes After focusing on processes DepartamentsDepartaments Processes Processes

21. 5. THE NEVER-ENDING TERMINOLOGY TRAPS. • CLINICAL PROTOCOLS • CLINICAL PRACTICE GUIDELINES • PRACTICE STANDARDS • PRACTICE PARAMETERS • . • . • CLINICAL PATHWAYS • CRITICAL PATHWAYS • CARE MAPS • COLLABORATIVE CARE • . • . • . • . • PROCESSES TYPOLOGIES

22. 6. THE MYTH OF LEADERSHIP “It is not enough to know what things should be done. One has to know also how to do them right”

23. AGAINST MYTHS AND TRAPS: The trick of greater scientific rigour and empirical validation of theories, methods and models.

28. DEAR AUDIENCE, IF YOU OR ANYONE YOU LOVE UNDERSTANDS THE PRECEDING CONVERSATION YOU HAVE MY DEEPEST SYMPATHY

29. Pedro J. Saturno ¡THANK YOU¡ Universidad de Murcia, España saber@um.es http://www.calidadsalud.com