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Second ESQH Spring
Workshop , March 22nd 2000. Domus Medica, Utrecht, The Netherlands.
Utrecht 2000 The Second ESQH Spring Workshop STATE OR THE UNION:Linking Policy and Actions on Healthcare Quality between The EU and Member States. took place in Utrecht in March of this year. The Workshop was organised by the Dutch Society for Quality (NVKZ) in collaboration with ESQH .Its objectives were:
The participants included representatives of national associations for health care quality and national and European health policy interests. Amongst the latter group were representatives of various national Ministries of Health, including the Dutch, as befitting the host country, and the Portuguese, as holders of the EU Presidency. The speakers
included JM van der Klaauw of the Dutch Ministry of Health, Welfare
and Sports, and Michael Hübel of the EU Commission. In his welcoming address, Mr van der Klauuw expressed his interest in the title and theme of the Workshop. He felt by discussing 'State or the Union,' that ESQH's initiative could be part of the beginnings of Governments working closer together in the field of healthcare .Mr van der Klaauw saw a parallel between pan European co-operation and a way of doing things that has evolved in Holland over the centuries. He referred to the Dutch 'poldermodel', which he defined as "a way of working together that in the end leads to a consensus among all parties." It developed as a response to the necessity of building dykes and polders, but now it is a model that the Dutch have attempted to apply to all aspects of running a modern society. Included in that of course is the field of quality improvement in healthcare. Every five years, a national conference is held in the Netherlands that brings together all those concerned with healthcare; the providers, the patients and the insurers. These groups then try to agree on a number of issues and work on that basis for the next five years. The Dutch Government then creates the legal framework to make it possible for care institutions to formulate their own quality systems - systems that have taken into account the views of the other parties at the Conferences. Setting up a quality system has to be done in such a way that it is embedded in everyday work within the institution. It also should lead to systematic quality improvement and assurance. And at the same time it should be possible to monitor developments from a management perspective. In the Netherlands, care institutions have to send a report annually to the Department of Health, but also to the regional patient organisations where the institution is located and to the regional Healthcare Inspectorate. In this way, quality systems are always closely monitored. New legislation has occasionally been enacted due to the strengthening role of patients. And further possibilities are constantly opening up with the development of new Information and Communication Technologies. Mr van der Klauuw pointed out that within the European Commission's Fifth Framework Programme billions of Euros have been allocated to health related matters. He expressed an interest in hearing from the Commission's representative how those Euros were going to be spent, particularly in the area of Information Technologies. He voiced the concern that while there is great scope for these technologies being applied in the world of healthcare, the focus needs to be on their effectiveness. Mr van der Klauuw finished by saying once again how this Esqh workshop was providing a great opportunity for discussion and exchange, for all those interested in improving quality in healthcare. Official Opening by The President of ESQH The President of ESQH, Mr Stiofan deBurca officially opened the 2nd Spring Workshop. His address was titled 'Linking policy and actions on Health Care Quality between the EU and Member States.' Mr deBurca outlined the effect various EU Treaties and actions were having on Member States, particularly in areas such as Provision of Healthcare, Public Health, Free Movement and Development of Quality Education. He charted the increasing political attention being paid to the Quality agenda, from the 1997 Council of Europe recommendations, through the Treaty of Amsterdam, and on to the Fifth Framework Research Programme. Mr deBurca then gave a detailed summary of the Quality Policies of each EU country, and of the actions taken. These largely fell under the headings of Models, Quality Processes, New Regulations and Targets. Mr deBurca concluded with a short overview of the development of ESQH, including its two previous Workshops, its new Website (www.esqh.net), and the hiring of an Executive Assistant to help run the Secretariat from its base in Limerick, Ireland. Wishing all the attendees an enjoyable and fruitful time in Utrecht, Mr deBurca then declared the Workshop officially open.
Mr Hübel began by thanking Esqh for inviting him to the Workshop, which he saw as an important attempt to explore how actions on quality of health care can link up and work together at Member state and Community level. He stated that the purpose of his presentation was to describe the general framework of the Community's activities in the area of health care. He wished to highlight a number of relevant actions to date, and to look at plans regarding the Community's future public health strategy.
2. Quality issues in health-related Community policies. Quality issues play an important role in a number of health-related Community policies, including:
Within the current scope of public health activities, two aspects relate to quality:
In 1995, the Commission put forward a Communication on the development of public health policy within the European Community. This document proposes three strands of activities for future Community actions in the public health field:
The Commissioner for Health has announced his intention to put forward a proposal for a new public health programme shortly. It will build upon the debate launched by the 1998 communication. There is scope to discuss and cover quality issues within the context of the policy framework proposed.
While the powers of the Community in the field of health are limited, there is a role to support Member States and develop activities concerning the collection and the exchange of information on developments related to best practice, including quality assurance. There is also a role to ensure that approaches developed by other Community policies related to quality contribute towards a high level of health protection.
The following are brief reports of the Workshops… The Union: Health policy of the European Union and its implications for quality of care. Stiofan deBurca and Michael Hübel. There needs to be a clear definition of "community" within the European Union. The European Union's input on policy relating to quality in healthcare can be in an advisory or more directive capacity. EU intervention can be seen as intrusion. Should the EU support quality policies or collaborate on policy construction? Means of action can take the form of
Key function
is learning and shaping policy in more effective ways. The Data: European information networks and trans-national data exchange. David Somekh and Thomas Ruprecht European information networks should contain key indicators which are validated. Issues relating to ownership and privacy of information networks need to be addressed and standardised For effective and efficient data exchange and networks, there needs to be questions makers, data input, information output resulting in knowledge and supported learning. The State :National policy actions and future plans: Iris Blomberg and Beat Selz The discussion at this Workshop centred on reconciliation of managerial and professional views. The motivation and aims of professionals, managers and state health officials is important in the development and action plans relating to National state policy relating to quality in healthcare.Governments policies and resources need to be directed towards quality policies and initiatives. Any recommendations developed must be followed by legislation. Currently there is too much emphasis being placed on Quality systems as opposed to active "quality in all work". All work should be quality work and perhaps sanctions should be considered as a penalty for not actively endeavouring to put quality systems in place .There is a large variety of culture in existence within the healthcare arena. Sensitivity is needed along with time, education and training for all health workers. This will involve behavioural change and leadership and will ultimately better outcomes. A common purpose with mutual understanding of all participants in the system, agreement on goals along with a common point of view that "it has to be right" are all required strands for effective and efficient quality systems to be put in place under legislation. Quality systems should be appropriate to productivity and with the combined ingredients of various systems, ie,. management and finance, a professional integrated quality framework will become established. |