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Message from the President, Stiofan deBurca The third issue of the ESQH Newsletter is being launched in Hungary, at the Conference for Organisational and Clinical Excellence in Central and Eastern European Countries. It gives me great pleasure to return to Hungary, where ESQH itself was launched just under 3 years ago. It is also an opportune time for some personal reflection on the progress
made during those 2½ years, as my tenure as President begins and
ends in Hungary. The past 12 months has seen us take on 2 employees. Firstly, we have our Executive Officer Noel Harrington who is based in Limerick, Ireland. It is Noel's responsibility to take care of the day to day running of the Society. He is the first point of contact for people getting in touch with ESQH. And in Brussels, working a three day week for ESQH, we have our Project Manager Benno van Beek. (You can read more about the Project Manager on Page 5.) The Balaton AGM is set to endorse a number of changes to the structure and operations of the Society. Firstly there is our revised and enlarged Constitution (See Page 6).
Our proposed Executive Board (Page 3) will ensure a dynamic focus on the
following areas of Quality in Healthcare: In summary then, I would have to say it has been a very enjoyable and
rewarding experience being the first President of ESQH. I would like to
wish my successor all the best, and trust that s/he finds the society
in good working order. 3rd Spring Workshop. Balaton WORKSHOP: Patient as Participant Welcome: Ms Ildiko Szy, Mr Stiofan deBurca, Prof Jan Mainz, Prof Tamas Simon, Semmelweiss University of Medicine. Methodology: Problems with Results Evaluation of Patient Satisfaction Surveys Panel Discussion - The Way Forward CHAIR: Isuf Kalo, Regional Advisor, WHO Europe.
It is appropriate that ESQH should participate in the CEEC Conference. One of the Society's aims is to become a network of networks within Europe, and with the continent becoming more unified between East and West, ESQH looks forward to working closely with healthcare professionals from all countries. We all have something we can learn from each other. This is the guiding principle behind sharing knowledge, and one practical way of doing this is through the holding of Workshops. ESQH's 3rd Spring Workshop is entitled 'Patient as Participant'. This reflects the growing awareness that all strategies to improve quality in healthcare will mount to little if the consumer is not acknowledged as the raison d'etre of the health services. Patients must be listened to, they must be kept informed and at all times, they must be kept in focus. The Workshop includes two examples of how patients are being listened to, through the undertaking of Patient Surveys. Firstly, we have Jan Mainz of the University of Århus, who will deliver a paper on a large survey of General Practice patients that was undertaken a few years ago throughout 16 European countries. And Angela Coulter, head of Picker Europe, will bring us the results of her considerable experience in the area of patients' views of hospital care. Tamas Simon of Semmelweis University will examine the methodology of evaluating the results of patient surveys. Stiofan deBurca, President of ESQH, will deliver the opening paper that will take an overview of Patient Participation as a growing and necessary strand of the Quality agenda. And Frank Steer of the UK Institute of Quality Assurance will propose the view that patients are not simply consumers. The complex relationship between patients and healthcare providers will be examined in his paper 'Patient Care is more than Customer Satisfaction'. Two of our Hungarian hosts, Ildiko Szy of the Ministry of Health and Laszlo Gulasci of the Hungarian Society will welcome delegates to the Workshop, and the Panel Discussion afterwards will be chaired by Isuf Kalo, Regional Advisor for Quality in Healthcare Systems for WHO Europe.
National Society Focus: Denmark In each issue of the ESQH Newsletter we intend to focus on one National
Society; their history, their current activities and their future plans.
In this way it is hoped that we can all get a closer glimpse of what is
going on in Europe Quality-wise, and if there room for learning from others.
We begin with Denmark…. The Society has a Board with 7 members, and a Committee on Education that organises the Society's courses, and a Scientific Committee that assess projects for the Quality Prize. National Quality Improvement activities National Board of Health, The Danish County Council Association, The Danish Medical Association, The Danish Nurses Organisation etc. This means that quality of care activities in Denmark are characterised by a strong collaboration among all relevant parties in The Danish Health Care System. Some of these National activities and projects include:
The National Strategy for Quality Development The National Council for Quality Development National Indicator Project The National Indicator Project aims at documenting and improving evidence-based prevention, diagnostics, treatment and rehabilitation. In this project all major diseases are to be evaluated.
For each disease, evidence-based specific clinical process and outcome
indicators are developed by health professionals (physicians, nurses,
physiotherapists etc.) at national level. Prognostic factors for each
disease are identified in order to adjust for case mix. All data is collected in clinical databases, so development over years can be followed. All data from the project is released to the public at national, county, hospital and clinical unit level. Hospitals are compared at departmental, county, national and international level. In order to interpret the results, audit activities are organised at county and national level. Improvements are implemented if necessary. The National Indicator Project is currently evaluating stroke,
hip fracture, schizophrenia, acute surgery, heart failure and lung cancer. National clinical databases In 1999 a concerted action was organised in order to make all clinical databases homogeneous regarding framework, technology, safety etc. All databases are analysed and adjusted according to high standards, so that they can fulfil their aims for research and quality improvement purposes. The National Secretariat for clinical guidelines National guidelines have been developed in several clinical areas. In the coming year guidelines will be developed with regard to stroke, hysterectomy and schizophrenia
Den Gode Medicinske Afdeling The Good Medical Department The task is development, testing and implementation of standards within
7 areas:
Quality is monitored by repeated national cross-sectional investigations by the use of indicators corresponding to selected standards. The individual departments have the opportunity to compare with one another and follow their own development of quality in the course of time. The results can be seen on the homepage www.dgma.dk Nationwide patient satisfaction studies Of Denmark's 100 hospitals, 70 participate. At each hospital, 600 consecutive patients are asked to fill in a validated questionnaire about their assessment of their hospital care. The first results were presented in January 2001. Adverse events project A system for continuous analyses of adverse events will be organised in connection with this project. Training and Education Since the beginning of ESQH, the Society has shown a keen interest in the area of Training and Education. It is seen as an effective way of bringing the results of Quality initiatives into practice. Quality modules have been and will continue to be introduced to all levels of healthcare training, from the most basic to the most advanced specialist courses. ESQH's first exploration into Education and Training came at the 1st Autumn Workshop held in Caltanisetta, Sicily in September 1999. The theme of the Workshop was "Developing Quality Healthcare Organisations through Learning, Education and Training". Five countries (The Netherlands, Spain, Italy, Ireland and Belgium) were surveyed to see the extent of Quality training in each. When seen together, the results of the survey showed that quality modules were much more likely in postgraduate professional training than in undergraduate. This led to the conclusion that many healthcare professionals were entering the system without formal quality training. Attendees at the Workshop also concluded that it was best that healthcare organisations developed their own quality systems, and to do this required specialist staff trained in quality who could help shape and direct those systems. (For a summary of papers delivered at Caltanisetta, contact info@esqh.net) The next step for ESQH's Training & Education team was to establish a Working Group who, encouraged by the level of interest generated in Sicily would take what was started there and build on it. Two members of the ESQH Council, Marius Buiting of CBO and Agnes Jacquerye of the Universite Libre de Bruxelles have begun working with Louk Hollands and Frank Verheggen of the University of Maastricht. The first meeting of this group took place recently. An initial task of this group will be to contact a leading expert in Training & Education in each of ESQH's Member countries, with a view to forming an informal 'think-tank'. In this way it is intended that an Inventory of Quality courses can be collected. An analysis of this Inventory should then provide the group with some method of comparing and contrasting these courses. A desirable but long-term outcome would be the development of a harmonised curriculum. A further aim of the Working Group will be to establish a 'Master Class for Masters,' where it is envisaged the top European experts in the field can come together to share ideas and develop future plans. New Members. EDOE. Constitution Update
At the Balaton AGM (May 2001) ESQH is due to form its Executive Board. This Board will be made up of The President, the Immediate Past-President and four elected Board Members. The function of the Board will be twofold; to assume day-to-day responsibility of the Society, and to apportion individual tasks to each Board Member. These tasks, which will form the cornerstones of ESQH policy and activities over the coming years, are as follows: 1. Training and Education 4. Leadership As well as being assigned one of these Portfolios, each Board Member will be expected to act as a Regional Officer for ESQH, linking with his/her own National Society and those of neighbouring countries. They will also represent ESQH in the Society's growing links with other Health and Quality organisations. The term of Office for the Executive Board is two years, with provision for re-election for one more term. The Member with responsibility for Special Projects will work closely with the Project Manager, Benno van Beek, who is based in Brussels. (See Page 3 for more about the Project Manager). The Member with responsibility for Internal Affairs will work with the Secretariat, which is based in Limerick, Ireland, and includes the Honorary Secretary Mary Halpin and the Executive Officer Noel Harrington. More details on Training and Education can be seen on Page 5, and on Indicators on Page 6 (EDOE). ESQH Project Manager ESQH's Project Manager began work in January of this year. He is Benno van Beek, a former (Quality) Policy Advisor for the Dutch Ministry for Health, Welfare and Sport. A graduate in Law, Benno has spent the past nine years working at the Ministry. In 2000, he was heavily involved in preparing the Ministry's position for the Leidschendam Conference. This conference is held every five years and brings together all the main players in the Dutch Healthcare system - health professionals, the Ministry, insurers and patient organisations. Benno was also involved in examining the development of information and communication technology and its impact on healthcare. The Project Manager is based in Brussels and has been given the task of assessing current and predicting future EU/EC policy as regards Health and ICT. This is to be achieved through dealing with EC officials, attending briefings and meetings, and generally keeping an ear close to the ground. At the same time, the Project Manager is in constant touch with the ESQH Secretariat and Council Members. He can act as a conduit of Brussels thinking and direction, and conversely as a disseminator of the ESQH name, personnel and projects. The first Project that is being looked at is the attempt to create a European Database of Indicators and Outcomes. You can read more about EDOE on Pg 6 Benno van Beek is part of the ESQH Training & Education Working Group and he will also be working with the Secretariat in developing the proposed ESQH Health & Quality Almanac. Specific plans for the Almanac are due to be discussed in Balaton, but the Project Manager, being based in Brussels, will be ideally placed for the crucial information gathering process. The Almanac will be ready for distribution in January 2002, and updated annually. Contact the Project Manager at:
European Database on Outcomes and Evidence Based Practice
Currently the EU and a number of member states are promoting use of Information and Communication Technology (ICT) in health care and are actively creating appropriate infrastructure and networks. With the increasing importance of Internet, as a universal communication medium, national borders are becoming irrelevant. EDOE is a joint initiative between the European Society for Quality in Healthcare, the Irish Clearing House on Health Outcomes (ICH) and the Danish Indicators Project. The aim of EDOE is to be a central web-based resource for current information on Outcomes and Indicators in Europe and beyond. The ICH, with co-operation of Prof. Jan Mainz of the University of Aarhus,
Denmark, is undertaking a review of current literature and databases on
indicators in Europe. This is a lengthy process but to date a significant
amount of information has been collated. For further information on Secretariat:
New Members for ESQH Recently ESQH has welcomed two new Members; Finland and Lithuania. Revised Constitution When ESQH was formed a brief Constitution was drawn up by the founding
Members. The growth of ESQH, the evolving management structure and the employment of staff have necessitated the revision and expansion of the original Constitution. This revised document is being put forward for ratification at the Balaton AGM. It was drafted by a working group of Stiofan deBurca, Marius Buiting, David Somekh, Mary Halpin and Noel Harrington, and a firm of solicitors in Limerick. The first draft was circulated to Members in December 2000, and a number of adjustments were made. One of the most significant aspects of the revisions is the formation of the Executive Board, and the replacement of the post of Vice-President with Immediate Past-President. The original Board will be re-named the ESQH Council. The new Constitution also provides for each Member Society to nominate a Deputy Representative, ensuring that each Member can maintain a steady presence at ESQH Teleconferences, Meetings, Workshops etc. If the Constitution receives ratification at the AGM, then it will be submitted to the Revenue Commissioners (Tax Office) in Ireland as part of ESQH's application for Charitable Status. Once ratified, the Constitution will be posted on the website |
