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Ähnlich wie Kwaliteit Verzilveren Cbo Flevum 310310
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Kwaliteit Verzilveren Cbo Flevum 310310
- 1. Utrecht, 31 maart 2010 Machteld Ploeg Zorgmanager Heelkunde Gelre Ziekenhuizen CBO – Flevum Forum Network Welkom bij … Hoe verzilver ik kwaliteit & ondernemerschap?
- 10. Vraagstukken ter verzilvering Sneek, 18 januari 2010 Verzilveren ondernemerschap -> RVE Ontwikkeling, KP! Verbeteren kwaliteit & uitstraling -> NIAZ, PV, Inspectie e.a. Vergroten T.W. p/e productie -> Ziekte%, Poli herinrichting SAP4OK, kwaliteit registratie Opzet netwerk low volume chirurgie, Gelre Academie, nieuwe vplkundige opleiding, mw´s tevredenheid! Flexpool Logistieke patientenstromen, flexibilisering OK capaciteit, e.v.a. O T S
- 11. Sneek, 18 januari 2010 klinisch operationeel/proces service financieel patiënt ziekenhuis medewerker medisch specialist zorgverzekeraar De BC gaat over impact en dus meer dan alleen financiën!!
- 12. DBC´s & de RVE: sturen op de waardeketen input: personeel , materiaal , apparatuur verrichting zorgproduct (DBC / DRG) Casemix manager specialist Kostprijsbepaling Zorgpad analyse Marktpositionering afdeling 1 2 3 input: personeel , materiaal , apparatuur verrichting zorgproduct (DBC / DRG) Casemix manager specialist Kostprijsbepaling Zorgpad analyse Marktpositionering afdeling 1 2 3 Bron: Zuurbier & Krabbe, Onderhandelen over DBC’s, Elsevier Maarssen, 2006, p.89). Drie doelmatigheidsniveaus
- 15. Verzilveren ondernemerschap is een nieuw spel!
Hinweis der Redaktion
- Verknopen van kwaliteit van zorg met ondernemerschap en een gezonde bedrijfsvoering Delen ideeen en ervaringen bij het verzilveren van kwaliteit Strategisch tactisch operationeel Marktwerking/gereguleerde marktwerking/budgetplafond Toegevoegde waarde Ovretveit/Porter Definitie kwaliteit Quality Chasm Pocketing dark green dollars – bigh fishes Bedrijfsvoering, operational excellence is meer dan deze kwaliteitsdefinitie Innovatie Passie Sturen op ondernemerschap en verantwoordelijkheden - RvE Is kwaliteit te verzilveren? Ja dat is geen issue meer al wordt het nog steeds bar weinig uitgerekend. Is kwaliteit in geval van marktwerking meer te verzilveren dan bij budgetplafonds en overschrijder betaalt Of leidt dit tot snel verminderen van het onderscheidend effect? Zoals ook verwacht mag worden van concurrentie op kwaliteit en veiligheid en op operational excellence en gezonde bedrijfsvoering?
- Stippen aan horizon RvE Winstverdeling, incentives, Overheidsbeleid stimuleert investment en innovatie (rapport Schrijvers en Ovretveit) en remt financiering van ‘slechte’ zorg af Veel operationele business cases! Secondly, whether the change saves money for a health service depends on whether the service bears the cost of its poor quality and of the solution. In some payment systems, longer stay due to infection, or a re-admission for a second operation due to an avoidable surgical complication, is not a cost but extra income. A service spending time and money improving discharge information might not gain savings, but the next ‘downstream’ service may do so because it saves them time. Often, a provider bears the intervention cost of the solution, cannot get the investment finance, or is financially rewarded for poor quality, giving a triple financial disincentive to improve. Purchasers have been slow to recognise and address these issues. Thirdly, it depends on how improvement is defined. Defined narrowly as using specific quality methods, those which focus on process change crossing many professions and services have the potential for the greatest savings, but also carry the greatest risk of failure and need the best implementation management, which may be difficult to achieve in the NHS. If defined broadly as any change that makes services better for patients, then some improvements have the potential to save money, especially if this includes more day cases, labour substitution or skill-mix changes, shifting services from hospital to primary care, and some reconfigurations. However, there is little evidence of savings from these, mostly because the research has not been done, or has not been able to show the contribution of the change to the saving.
- Onze missie luidt: Het bieden van hoogwaardige medisch specialistische diagnostiek, behandeling en zorg aan patiënten in hun eigen leefomgeving. Patiënten beleven de zorg als veilig, betrouwbaar en deskundig en worden in een patiëntvriendelijke sfeer opgevangen. De kernwaarden voor de identiteit van Gelre zijn: deskundig, betrokken, bereikbaar en behulpzaam. Dit lijkt een missie zoals je die bij veel ziekenhuizen zou kunnen aantreffen. Voor Gelre staat echter voorop dat wij er voor willen zorgen dat de patiënt, die ziek is en daardoor vaak onzeker en afhankelijk, de benodigde zorg zo dicht mogelijk bij huis, in de buurt van hun dierbaren, kan ontvangen. Wij willen voor de patiënt deskundig, betrokken, bereikbaar en behulpzaam zijn. Deze missie betekent dat de medische behandeling en zorg zich op een zo breed mogelijk vlak moet uitstrekken en van een zodanig hoog niveau moet zijn dat de gedwongen uitstroom buiten het eigen verzorgingsgebied tot het minimum beperkt blijft. Uitstroom accepteren wij alleen voor zeer specifieke top-klinische zorg, zoals bijvoorbeeld hartchirurgie.
- The most successful hospitals or primary care organisations are not the ones which just deliver the best evidence-based clinical services, or are most focused on safety, or who’s services are highly customer-oriented, or which consistently managed to balance their budgets. The most successful healthcare organisations are the ones which recognise the multi-faceted nature of their endeavour and manage to deliver across all of the dimensions of quality. Martin Marshall Director of Clinical Quality, the Health Foundation The report suggests that although the scientific evidence is not strong, improvement initiatives can reduce costs to service providers. To achieve this requires careful planning, leadership, expertise, perseverance and not a little healthy scepticism. It especially requires a sustained and relentless focus on high-quality implementation. The report identifies gaps in our understanding of how to achieve substantive and sustainable change and lays down challenges to managers, clinicians, policy makers and academics. Meanwhile, the Health Foundation is taking a lead in rising to these challenges. Does improving quality save money? Sometimes, but sometimes not, and mostly we do not know because the research is limited. There is a great potential for savings, but it depends what we mean by quality improvement, who makes the savings and when.
- Cost of poor quality Costs of poor quality. The research reviewed shows that poor quality is common and costly. There is evidence of the high financial and human cost of poor quality in the harm caused by healthcare, and by sub-optimal care in the overuse, misuse and underuse of treatments. Intervention costs of solutions. The evidence shows that some solutions for poor quality are effective, such as prophylaxis before surgery or computer physician order entry. But there is less evidence of the effectiveness of other proposed solutions, especially when generalising to other sites. research shows great variation in the implementation of solutions and why this may be so. Quality improvement can be costly, especially in services with little experience or infrastructure to support improvement. The review found that many studies which reported ‘savings’ did not assess the cost of the intervention, left out some costs, or did not use actual cost data from the service. Savings depend on the financial system, and on who bears the costs that are distributed between different stakeholders.
- The available evidence suggests that savings are possible through careful choice of change solutions, skilful implementation using quality methods and attention to the political and people aspects of change. The chance of success is higher if there are certain enabling conditions, such as financial incentives. Choose improvements already proven to make services better for patients and reduce costs, especially in a similar service. Where there is little research, use reported experiential evidence to guide action, but speak personally to the implementers, ask what helped and hindered and be positivity sceptical. Make your own estimates of the current poor quality cost, the intervention cost for a 50 per cent solution, when the intervention costs will start paying for themselves (time to pay off) and the annual potential savings. Then track these costs. Research has shown this can be done well enough for practical purposes using routinely available data. Adapt the change and manage implementation skilfully, especially the people aspect, using the methods, expertise and experiences of others. Measure and monitor progress and make corrections according to changing circumstances. Join with others to change financial systems, and other external hindrances, to help you invest in changes and build improvement capacity. The most used definition of quality in healthcare is from the Institute of Medicine (IOM) (2001). The CBO uses the same definition for quality as the IOM (2001). This definition is used by several international health care institutes. The IOM (2001) defines quality as: “ quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, 2001; RIVM, 2010).” According the IOM (2001) quality in healthcare contains six different strongly related domains (Table 1). Quality aspect Description Safe “avoiding injuries to patients from the care that is intended to help them” Effective “providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.” Patient-centred “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” Timely “reducing waits and sometimes harmful delays for both those who receive and those who give care”. Efficient “avoiding waste, including waste of equipment, supplies, ideas, and energy.” Equitable “providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.” Table 1; Quality domains (IOM, 2001) In respect to the quality definition of Hardjono
- Strategisch niveau Vraagstukken als wel/geen buitenpoli, ZBC e.d. Of houden we alle specialismen aan? Welk level van patientveiligheidsbeleid en imago/PR Tactisch niveau Houden we alle DBC’s aan? Of hoe kunnen we binnen een specialisme / afd. doelmatigheidswinst behalen? Pveiligheidsbeleid per specialisme, kosten en opbrengsten Operationeel niveau Hoe verbeteren we de kwaliteit van peri operatieve zorg en welke financièle consequenties heeft dat ? Borging van de IGZ indicatoren, te weten: - Delier, decubitus, pijn, ondervoeding, vallen. Verbeteren medicatieveiligheid. Zichtbaar maken van kwaliteit oa. door de veiligheidsrondes. Veegactie bouwkundige randvoorwaarden. Afronding VMS thema’s in 2010 en 2011. We hebben het dan o.a. over: Telefonische bereikbaarheid. Bejegening. Invulling van de baliefunctie. Klachten en klachtafhandeling. Fouten.