Quality Management
Brigitte Domittner
Gesundheit Österreich GmbH
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Topic Points
 Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Gesundheit Österreich GmbH, Vienna
Organisation Status
 Limited company owned by the Federal State of Austria
 State is represented by the Austrian Ministry of Health
 Non profit organisation
 Independent in our scientific work
 Legal Basis
•
Federal Law for establishing “Gesundheit Österreich GmbH”
•
Federal Law on Quality for Health Services for establishing BIQG
•
Health Promotion Law for establishing Fund for a Healthy
Austria (FGÖ)
Main tasks
 “Think-Tank” for the Austrian Health Care System.
 Supporting Ministry of Health, provinces and other
stakeholders in preparing policy briefs, statutory
regulations, etc.
 Scientific research and analysis
 Provision of information for nationwide planning, regulation,
governance and (economic) evaluation in health care
 Health Promotion and Preventive Health
 Development, implementation and evaluation of a
nationwide quality system.
 Participation in national and international projects and
working groups
Topic Points

Introduction Gesundheit Österreich GmbH
 Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Definition of quality
Origin: Latin quālitās “of what sort”1
= “the standard of something as measured against other things
of a similar kind; the degree of excellence of something”1
Informal: quality = good quality
Individual judgment of quality depends on various aspects, e.g.
experience, education, environment
1www.oxforddictionaries.com
Quality specifies …
... the extent to which a product (good or
service) meets the existing requirements/
standards.
In a nutshell: Evidence of good quality is...
... when the
customer
returns and
not the product!
Evolution of Quality
Evolution of Quality I
 Finding mistakes/errors
 External assessment/control
 Culture of mistrust
 Inspecting
the past
Evolution of Quality II
 avoid mistakes
 personal responsibility /
ownership
 culture of trust
 Looking into
the past and
plan for the future
Evolution of Quality III
 Systematic fulfillment of
customer requirements
Evolution of Quality IV
 Participation of all members of
an organization
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality
 Total Quality Management

Quality Management Systems used in health care
organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Total Quality Management
» Organization wide management philosophy for
continuously improving the quality of products /
services and its processes
» Continuously quality improvement is the
responsibility of everyone who is involved in the
production or use of the products or services
offered and hence is interested in its quality
Source: Øvretveit, (2000): Total quality management in European healthcare
Who is interested in quality?
Customer
satisfactory quality of received
product / service
Employees
workplace satisfaction, career
opportunities ...
Owner
maximum created value
Supplier
long-lasting business relationship
Society
responsible and sustainable behaviour
Total Quality Management
» Organization wide management philosophy for continuously
improving the quality of products and processes
Main components:
» Focusing on consumer (and suppliers)
» Analysing processes
» Working in quality project teams
» Systematically analysing quality problems, planning change
und evaluating the results
» Using data to identify and analysing problems and evaluating
the results
» Implementing change
Source: Øvretveit, (2000): Total quality management in European healthcare
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management
 Quality Management Systems used in
health care organizations

Importance of Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Quality Management Systems used in health care
organizations
Selected Systems:
» International Organization for Standardization – ISO
» European Foundation for Quality Management – EFQM
» Joint Commission International – JCI
» The Cooperation for Transparency und Quality in Healthcare KTQ
Quality Management Systems used in health care
organizations
Selected Systems:
» International Organization for
Standardization – ISO
» European Foundation for Quality Management – EFQM
» Joint Commission International – JCI
» The Cooperation for Transparency und Quality in Healthcare KTQ
International Organization for Standardization (ISO)
» 1946: Meeting of delegates from 25 countries at the Institute
of Civil Engineers in London
subject: ‘to facilitate the international coordination and
unification of industrial standards’
» 1947: Creating the International Organization for
Standardization
» 2012: ISO is a network of national standards institutes from
163 countries
» 2012: Over 19 000 International Standards covering almost
every aspects of technology and manufacturing
Source: www.iso.org
ISO 9000 ff Quality Management
» Originally developed for the industry
» Increasing use of standards in other areas (e.g. healthcare)
» 2000: General revision and simplification of the ISO 9000
series (=Quality Management)
There are many standards in the ISO 9000 family, e.g:
» ISO 9000:2005 - covers the basic concepts and language
» ISO 9001:2008 - sets out the requirements of a quality
management system = base for certification
» ISO 9004:2009 - focuses on how to make a
quality management system more efficient and effective
» Current: Review of a European Standard for health care
services – requierements based on EN ISO 9001:2008
Source: www.iso.org
ISO Model of a process-based quality management
system
Source: www.iso.org
ISO Quality Management Principles
Source: www.iso.org
ISO - Certification
» ISO develops International Standards and does not itself
certify organizations
» External certification bodies perform the certification
Procedure:
1. Preliminary Audit (optional)
2. Documentation Review
3. External audit by an external certification
4. Issue of certificate  valid for 3 years
5. Surveillance Audits  internal auditing by trained internal
staff  every year
6. Certification Renewal
Source: www.iso.org
Certification versus Accreditation
Certification
» written assurance (the certificate) by an independent external
body that processes or products conform to the requirements
specified in the standard
Accreditation
» Is a formal recognition by an accreditation body that a person
or institution is competent to carry out the certification in
specified business sectors (= certification of the certification
body)
» Terms accreditation and certification are often used
incorrectly synonyms
Source: www.iso.org
Quality Management Systems used in health care
organizations
Selected Systems:
» International Organization for Standardization – ISO
» European Foundation for Quality
Management – EFQM
» Joint Commission International – JCI
» The Cooperation for Transparency und Quality in Healthcare KTQ
European Foundation for Quality Management – EFQM
» Founded in 1989 by 14 European organisations, in order to
increase the competitiveness of European organisations
» Not-for-profit membership foundation based in Brussels
» Creater of „The EFQM Excellence Model“
» The aim of the Model is to improve performance in order to
reach „Excellence“
» 2012: more than 30 000 organisations in Europe use the Model
» Provide training, assessment tools and recognition for high
performing organisations  EFQM Excellence Award
Source: http://www.efqm.org
European Foundation for Quality Management – EFQM
Detailed information in a separate presentation!
Source: http://www.efqm.org
Quality Management Systems used in health care
organizations
Selected Systems:
» International Organization for Standardization – ISO
» European Foundation for Quality Management – EFQM
» Joint Commission International – JCI
» The Cooperation for Transparency und Quality in Healthcare KTQ
Joint Commission International - JCI
Joint Commission on Accreditation of Healthcare Organizations JCAHO
» Founded in 1951
» Independent, not-for-profit organization
» Define quality standards specially tailored for health care
facilities
» focuses on safety quality of medical services, patient and
employee satisfaction
» All processes are assessed (from patient registration,
examination, treatment up to the transfer and discharge of a
patient)
» Accredits and certifies more than 19,000 health care
organizations and programs in the United States
» The whole organization, not just individual departments are
being evaluated
Source: www.jointcommissioninternational.org
www.jointcommission.org
Joint Commission International - JCI
Joint Commission International – JCI
» Created in 1994
» Implements the goals of the JCAHO at an international level
» Supports health care organizations through accreditation,
education and technical assistance
» Accreditation of an organization: Is a recognition given to the
healthcare organization, which meet the
JCI standards
» JCI has a presence in organizations in
more than 90 countries
Source: www.jointcommissioninternational.org
www.jointcommission.org
Quality Management Systems used in health care
organizations
Selected Systems:
» International Organization for Standardization – ISO
» European Foundation for Quality Management – EFQM
» Joint Commission International – JCI
» The Cooperation for Transparency und
Quality in Healthcare - KTQ
The Cooperation for Transparency und Quality in
Healthcare - KTQ
» initiated in 1997 by the German federal chamber of
physicians (BAeK) and the federal associations of various
health insurance funds. Later joined by the hospital federation
and the nursing council
» Is an organization which offers quality management
certification for health care organizations
» Mission is to strengthen transparency in the performance of
hospitals through providing comprehensible information to all
concerned, including patients (quality report)
» KTQ analyzes and reviews medical, nursing and administrative
processes
»  Certifies health care organizations
Source: www.ktq.de
The Cooperation for Transparency und Quality in
Healthcare - KTQ
» 1. Self-assessment
Self-assessment of the organization based on the KTQ
catalog .
 Describes the present situation, identifies room for
improvement and establishes inter-departmental
communication structures
» 2. External assessment (site visits)
External assessments on site though qualified KTQ visitors
» 3. Quality report and issue of certificate
Score higher than 55% in external assessment
 issue of a KTQ certificate (valid 3 years)
Source: www.ktq.de
(Certified) QMS - what could be the benefits?
e.g.:
» Optimized work processes
» overall quality improvement
» Marketing Tool
» Feedback from experienced external auditors/visitators
» Increased patient safety
» Increased patient satisfaction
» Optimized existing resources
» ...
(Certified) QMS - what could be the disadvantage?
e.g.:
» Higher costs to health care
» Added bureaucracy
» Time consuming
» Not being very practical for the organizations (ISO)
» Focusing primarily on processes and structure, less on
outcome
» Implementation of standards are too lenient
» Process does not end with the final implementation and
certification  system needs maintaining without an final end
» …
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations
 Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at

Detailed Information about the questionnaire for quality
reporting
Continuous Quality Improvement
» Based on the Japanese philosophy of “Kaizen”
» Kaizen means “good change" ,
„change for the better“
» Never-ending efforts for improvement
(continuous learning from mistakes,
organisational learning)
» Involving everyone in the organization (all
hierarchy level, from the CEO to the lowest
level workers)
» Process oriented rather than outcome
 From small steps to big results
改
Kai
善
Zen
PDCA-Cycle (W.Edward Deming)
Effects of Continuous Quality Improvement
» Detects resources and synergies
» Optimizes workflows /processes and systems
» Improves the product / service and customer satisfaction
» Optimizes the use of resources
» Supports skills, creativity and commitment of the employees
» Improves team work and corporate culture
» BUT can also increase the “pressure to perform” for
employees
… rowing is not enough!
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations

Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres:
Platform

The Quality
www.qualitaetsplattform.at
Detailed Information about the questionnaire for quality
reporting
The Quality Platform: www.qualitaetsplattform.at
The Quality Platform: www.qualitaetsplattform.at
Project goals:
» Regular, nationwide quality reporting on key indicators for
quality structures and processes in Austrian hospitals 
Benchmarking & incentive to build capacities
» Sharing information about various projects  community of
practice
» Data collection via an access-protected website:
www.qualitaetsplattform.at
structure database
project database
Development of „The Quality Platform”
» until 2004: previous project www.qbe.at - no report
published
» 2008, 2009: Evaluation and revision of the previous
questionnaire (How should the report be designed, What
kind of information should be in it?)
 Interviews, questionnaire survey, evaluation workshops,
expert panels
Goal: questionnaire about structures and instruments of
quality work in Austrian health care institutions
» 2010: Completing the questionnaire, programming the new
website and launching the new quality platform at a national
quality conference
General Framework
Contracting authority:
» Federal Health Agency (Bundesgesundheitsargentur)
Policy framework “Quality reporting”
» The Act on Health Care Quality (Gesundheitsqualitätsgesetz)
» Austrian Quality Strategy (Qualitätsstrategie)
» 2011: Amendment of Law on Hospitals
(Krankenanstaltengesetzt)  mandatory participation (before
participation was voluntary)
Topic Points

Introduction Gesundheit Österreich GmbH

Definition and evolution of Quality

Total Quality Management

Quality Management Systems used in health care
organizations

Continuous Quality Improvement

Regular reporting on the quality systems in Austria’s
hospitals and rehabilitation centres: The Quality Platform
www.qualitaetsplattform.at
 Detailed Information about the
questionnaire for quality reporting
The Quality Platform: structure database
Main content points
» General description
» Structural embedment of quality work
» Quality Management Models
» Quality work
Indicators - structure database
Structural embedment of quality work
» Mission statement
» Quality strategy
» Quality Assurance Commission (staffing, internal regulations)
» Coordination of quality work (organisation, staffing, qualification)
» Quality management models (ISO, EFQM, CJ)
» Quality work
o Processes/Standards
o Admission/Discharge procedures
o Operative management
o patient-orientation
Rights of patients (information, trainings)
 Patient satisfaction survey (topics of questionnaire, intervals,
results)

Indicators - structure database
o Employee-orientation




o
o
o
o
Employee satisfaction survey (topics of questionnaire,
intervals, results)
Structured staff appraisal
advanced training (documentation, coordination)
workplace health promotion
Suggestions and complaints (survey method, handling,
analysing, employee suggestion system)
External quality-projects
Patient Safety and Risk Management (instruments,
reporting systems organisation, staffing, qualification)
Continuous Quality Improvement
Example for evaluation graphic
In how many departments there are defined contact persons for
risk management? (n = 82)
Response: in all/in many/in
some departments
Example for evaluation graphic
Quality models in Austrian hospitals > 80% of KH have a Quality
Model implemented or a planning to do so
0
5
ISO implementiert
25
30
35
40
20
3
38
EFQM geplant
5
CAF implementiert
0
0
CAF geplant
0
11
1
0
KTQ geplant
13
1
0
JCI geplant
10
1
2
4
Sonstige implementiert (Summe)*
Sonstige geplant (Summe)*
20
11
0
45
41
4
EFQM implementiert
JCI implementiert
15
5
ISO geplant
KTQ implementiert
10
26
6
für Teile der Organisation
für die gesamte Organisation
The Quality Platform: project database
» Name of the project
» Contact person
» Timeframe for the project
» Brief description of the project
» Target group
» Project orientation (patient,
employees, relatives, public...)
» Evaluation
Benefits of „The Quality Platform“
» Transparency: National overview of structures, tools and
projects in hospitals and rehabilitations centres
» Benchmarking: the individual organization can benchmark
itself with the Austria-wide results
» Automated analysis and download their own data (eg internal
reports)
» Networking, information and experience for members
» Information section on the website of the quality platform
(link collection, downloads, etc.)
Other Initiatives
» Nationwide uniform survey on patient satisfaction
across sectors
» Austrian Inpatient Quality Indicators – A-IQI
„Evidence of effective change
+
Effective implementation method
+
Supportive environment and infrastructure
=
Improved quality“
Source: Øvretveit, John (2009): Does improving quality save money? A Review of Evidence of which Improvement to
Quality Reduce Costs for Health Service Providers. The Health Foundation, London
Thank you for your
attention!