Accelerated Improvement: The Better Faster program

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Accelerated Improvement The Better Faster program

• Peter J. Wognum
• Policy adviser on curative care
• Ministry of Health, Welfare and Sports
• Barcelona, april 18th 2007

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Basic Problems in Health Care I

• overuse, underuse, misuse (patient safety)
• access-problems, waiting times, delays,
  coördination problems, communication gap
  (organisational problems)
• Lack of co-decision making, patient view ,
  empathy (zeggenschap)
• Relation between ever growing costs and better
  results uncertain - value for money?
• Management of health care institutions dont
  steer on (chain)quality
• Too much attention to instruments and procedural
  aspects of care too few attention to results

3
Basic problems in healthcare II

• Innovations develop, but implementation and
  diffusion are too slow (rate of change) - good at
  generating but not always so good at generalising
• Patient perspective underdeveloped patient is
  not aware that differences exist or what can be
  done. He is not able to really influence this
• Patient has no insight (transparancy) in type and
  quality of care and is not able to choose
• Relation ICT and quality policy underdeveloped
• Role of insurance companies growing but not
  enough
• Need of more active role of health care
  inspectorate

4
The right momentum

• New law on health insurance
• New financing system for hospitals
• DBCs diagnosis treatment combinations
• Nationwide action on ICT-improvement
• DBC-registration
• medication
• Growing influence of health insurance companies
• More freedom on contracting and price
  negotiations
• More transparancy on results
• Health care inspectorate yerly reports
• newspapers
• More public and political demand for clear
  results
• Several incidents on safety (heartsurgery)

5
Acting on all levels
Project and Programme based Improvement
Strategically Focused Large-System Change
Building Improvement Into Daily Work
Leadership for Improvement
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Aims of Better Faster program

• show that bold aims on patient logistics and
  safety are possible
• Create a new attitude to continuous improvement -
  making modernisation mainstream
• Show that new standards are set and obligatory
  for all

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Basic setup of the program

• initiated by the ministry of health
• announced to 2nd chamber nov 2003
• 3 pillars enhancing awareness - indicators for
  safer and better care accelerated spread of
  best practices
• 2004-2008 - 14.000.000
• Ministry together with partners - leagues of
  medical specialists, hospitals and nurses.

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Pillar I - Enhancing awareness

• Reports by CEOs of Shell (safety), TNT
  (logistics), Aegon (transparancy) and KPN
  (innovation).
• Numerous discussions active involvement of
  minister
• Database best practices
• Website, twice weekly newsletter, interviews,
  etc, etc.
• Actively supported by SB-partners

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Pillar II indicators for safer and better care

• Initiated by health care inspectorate
• Yearly publication of 26 hospital indicators
• Much newspaper attention
• Focus for next years on 80 disease specific
  indicators, HSMR and evidence based interventions

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Pillar III the Hospital Change Program Project

• 4 year program
• 38 hospitals (20)
• Each involved for 2 years
• 10-12 projects first year, 20-25 project second
  year
• .

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The next phase

• Actionprogram on safety
• Safety management system
• evidence based interventions
• indicators
• Hospitals, nursing and elderly homes, etc.

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discussion

• A nationwide continuous quality improvement in
  hospitals is only possible if a right balance
  exists between
• intrinsic professional motivation (want to
  improve)
• knowledge (knows how to improve campaign and
  project based improvement strategies)
• extrinsic factors (has to improve price,
  market/new competitors, inspectorate,
  transparancy, public demand, etc.).
• In almost all countries this balance is not yet
  in place.
• review in your group whether in your country
  major actions on all three levels exist.
• which do you consider most important?