Academy Health Annual Research Meeting | Boston | 26-29 June 2010
Quality Development in Long-Term Care:
An Overview of European Approaches
Kai Leichsenring
European Centre for Social Welfare Policy and Research
Vienna | Austria
Based on contributions by Henk Nies, Sabina Mak, Roelf van der Veen (NL), Ricardo Rodrigues (AT), Pierre
Gobet, Elisabeth Hirsch Durrett, Marion Repetti (CH), Michel Naiditch (FR), Teija Hammar, Hennamari Mikkola,
Harriet Finne-Soveri, Timo Hujanen (FI), Laura Holdsworth (UK), Stephanie Carretero, Laura Cordero, Maite
Ferrando (ES), Thomas Emilsson, Gunnar Ljunggren (SE), Patrizia Di Santo, Francesca Ceruzzi (IT), Eva Turk (SI)
Funded by the European Commission
under the Seventh Framework Programme
Grant agreement no. 223037
Aims of the presentation
•
To present first results of the ongoing project INTERLINKS (EU FP7, DG Research)
• National reports – European overview papers
•
To show how emerging long-term care (LTC) systems in Europe are dealing with
issues of quality management and quality assurance in various settings of LTC for
older people
• Quality management and quality assurance across the ‘care chain’ still missing
•
•
Scattered approaches between health and social care, and within LTC
To illustrate some recommendations for research and policy with examples of
(good) practice

Presented by Kai Leichsenring • Boston, 2010-06-29
1
Background
•
EU Seventh Research Framework Programme 2007-2013: Health
•
INTERLINKS is co-ordinated by the European Centre for Social Welfare Policy and
Research – it gathers 16 Partners from 14 countries (2008-2011)
•
The aim is to develop a concept and methodology to describe, analyze and
improve long-term care and its links with the health system
•
Cross-national comparisons, practical tools, evidence-based models of good
practice
•
Focus on informal care, prevention and quality in LTC
16 Partners from 14 countries
•
•
•
•
•
•
•
European Centre for Social Welfare
Policy and Research (Coordinator)
Ecole d'études sociales et pédagogiques
(CH)
University of Southern Denmark (DK)
Institut de Recherche et Documentation
en Economie de la Santé - Irdes (FR)
National Research and Development
Centre for Welfare and Health – Stakes
(FI)
Institut für Soziale Infrastruktur (DE)
Wissenschaftszentrum Berlin für
Sozialforschung – WZB (DE)
• CMT Prooptiki ltd. (EL)
• University of Valencia – ERI
Polibienestar (ES)
• Studio Come S.r.l. (IT)
• Vilans (NL)
• Institute for Labour and Family
Research (SK)
• Institute of Public Health (SI)
• Forum for Knowledge and Common
Development, Stockholm County
Council (SE)
• University of Kent (UK)
• University of Birmingham (UK)
Presented by Kai Leichsenring • Boston, 2010-06-29
2
Terminology of a not (yet) a consolidated system of long-term care, but emerging practices
The health-social care divide
Social care
system
Services
Residential care
Providers
Professions
Methods
Legal Framework
Policies
Long-term care
linked-in, co-ordinated,
integrated?
Identity - Policies - Structures Functions - Processes Resources/Funding
The formal –
informal divide
Users
Informal carers:
family, friends,
‘migrant carers’
Presented by Kai Leichsenring • Boston, 2010-06-29
Why quality management in LTC?
•
•
New Public Management in health and social care
•
Introduction of quasi-markets
•
•
New private (for-profit) providers
Competition
•
Public purchasers: tendering, contracting, commissioning
Introduction of attendance and care allowance schemes
•
•
Choice and transparency
Professionalisation
•
Expert standards and LTC identity
Presented by Kai Leichsenring • Boston, 2010-06-29
3
Health care
system
Hospitals - Services
Providers - Professions
GPs - Methods
Legal Framework
Policies
Different approaches and structures in Europe
•
Central vs. decentral regulation
•
•
Public vs. private provision (welfare mix)
•
•
Different importance of public, private non-profit and commercial providers
Inspection and quality assurance vs. quality improvement
•
•
National guidelines (eg. England, Finland) and regional/local criteria (eg. Austria,
Italy, Spain, Switzerland)
How to trigger continuous improvement?
The health and social care divide in quality management
•
Different methods and resources: ‘silo approach”
Presented by Kai Leichsenring • Boston, 2010-06-29
Main trends in QA and QM in LTC
•
From inspection to self-assessment and third-party certification
•
Disclosure of data and more transparency: Towards benchmarking?
•
From minimum standards towards models of excellence
•
From structural and process quality to results and outcome indicators
•
Quality management as a part of professional profiles or yet another
bureaucratic driver of costs?
•
The challenge of quality management across agencies and across sectors
Presented by Kai Leichsenring • Boston, 2010-06-29
4
From inspection to self-assessment
Mode of quality
assessment
Inspection of
products / services
Quality
management
Models of
excellence
Main principle
Quality control and
assurance, minimum
standards
Developing process
quality
Continuous
improvement
Assessment tools
and methods
Internal control, selfregulation,
check-lists,
external control
Internal quality
management,
Third party
certification
Internal QM, Third
party certification,
(evidence-based)
expert standards,
benchmarking
Check-lists (DE);
KLORA (UK)
EN ISO 9000ff.; KTQ
(DE); HKZ-V (NL);
ANGELIQUE (FR)
TQM, M. Baldridge
Award, EFQM; E-Qalin
(AT, DE, SI, LU)
Examples
Presented by Kai Leichsenring • Boston, 2010-06-29
5
Beyond minimum standards
•
•
The dilemma of minimum standards
•
If some care providers still do not even comply with minimum standards
•
BUT: minimum standards may impede innovations by other providers
Constantly changing environments and expectations, but legally defined
standards partly stemming from the 1990s
•
Minimum standards without any evidence base
•
Examples: composition of qualifications and staff ratios
Presented by Kai Leichsenring • Boston, 2010-06-29
Visions & Values
National, regional, local
Legal requirements
Developing results-oriented quality indicators
Structural
quality
Process
quality
Outcome
quality
Methods / Know-how
Presented by Kai Leichsenring • Boston, 2010-06-29
6
Quality management as a part of the job profile?
Organisational
hierarchy
0%
Percentage of
management tasks
100%
Presented by Kai Leichsenring • Boston, 2010-06-29
Some examples of good practice
•
Finland
•
•
The Netherlands
•
•
The INTER-RAI experience
Quality Framework for Responsible Care
Austria, Germany, Luxembourg, Slovenia (England, France, Italy ...)
•
E-Qalin®, a QM system developed in a European context to match with
specificities of social and health care services
Presented by Kai Leichsenring • Boston, 2010-06-29
7
The challenge of quality assurance and quality
management across agencies and sectors
•
•
Initiatives at the very beginning
•
UK: World Class Commissioning (NHS)
•
NL: First steps
The challenge of LTC specific quality indicators
•
•
Customer/user/client/patient satisfaction surveys
Quality of life and quality of care
•
•
Economic performance and sustainability
Leadership and context indicators
Presented by Kai Leichsenring • Boston, 2010-06-29
Mixed feelings in population: “Care staff are
highly committed and are doing an excellent job”
Slovakia
Slovenia
EU27
Agree
Disagree
Don't know
Germany
Netherlands
Denmark
Sweden
0%
20%
40%
60%
Presented by Kai Leichsenring • Boston, 2010-06-29
8
80%
100%
Source: Eurobarometer, 2007
Money matters, but we do not know how much!
Public LTC expenditures as a
percentage of GDP
Poland
Spain
Huber et al, 2009 (2007 data)
OECD (2005 data)
EC/DG ECFIN, 2009 (2007 data)
EU27
Germany
Denmark
Netherlands
Sweden
1,0
2,0
3,0
4,0

0,0
Presented by Kai Leichsenring • Boston, 2010-06-29
Thank you very much for your interest!
• Further information
•
•
www.euro.centre.org
www.euro.centre.org/interlinks (public website by the end of 2010)
• Contact
•
•
leichsenring@euro.centre.org
European Centre for Social Welfare Policy and Research
Berggasse 17
A-1090 Vienna (Austria)
•
Phone: +43 699 10198092
Presented by Kai Leichsenring • Boston, 2010-06-29
9
Acknowledgements
•
The European Commission, DG Research
The Seventh Framework Programme – Health
•
Henk Nies, Sabina Mak, Roelf van der Veen (Vilans, NL), Ricardo Rodrigues
(European Centre, AT), Pierre Gobet, Elisabeth Hirsch Durrett, Marion Repetti
(EESP, CH), Michel Naiditch (Irdes, FR), Teija Hammar, Hennamari Mikkola, Harriet
Finne-Soveri, Timo Hujanen (THL, FI), Laura Holdsworth (University of Kent/CHSS,
UK), Stephanie Carretero, Laura Cordero, Maite Ferrando (ERI Polibienestar, ES),
Thomas Emilsson, Gunnar Ljunggren (Forum KCD, SE), Patrizia Di Santo, Francesca
Ceruzzi (Studio Come, IT), Eva Turk (IPH, SI)
Presented by Kai Leichsenring • Boston, 2010-06-29
10