Quality of care remains the most important aspect for every patient as well as the first selling proposition of every hospital. A great principle, but extremely difficult in practice. Of great help is the fact that there is a strong correlation between the quality of care and safety, cost-effectiveness and the satisfaction of both consumers/ patients and workers.
Mr. Berden examined the question of how quality can be improved and stressed that this should be sustainable. As well as the well-known and useful instruments such as standards, protocols and checklists, the decision- making process at a professional level also plays an important role.
In the Netherlands there are around four serious incidents per year discussed heavily in the press and parliament. 25% of cases are over-treated and 35% under-treated. There are large differences in professional compliance and also between institutions. From the US experience we have learnt that poor quality is expensive.
So what improves quality and what does not?
Transparency can be effective if the source is reliable, if we are shown how it can be done better and if it is repeated on a regular basis.
Involvement of the Patient: considering the dreams, expectations of the patient. Berden believes the Boivin level of involvement is of help when exploring the needs and experiences of the patient through consultation, when informing the patient about the quality and involving the patient. A better organised system is also very important. Quality of care is managing complexity so the organisation of the care process, including coordination, using protocols, guidelines and checklists and also improving the effectiveness of the team, is important. Changing the system is the best way of changing individuals but this is something yet to be implemented in many hospitals.
Commitment of professionals: healthcare workers make the system and make the mistakes (clinical and managerial). Yes, commitment is effective but it is not natural. According to Berden we need a new professional mindset of being accountable, being a team member and accepting the context. This mindset is created through education and socialisation.
Leadership is a critical success factor that we must be aware of and use to improve quality and safety:
A conditio sine qua non!
Including our leadership!
To conclude, Berden reiterated that these five points are vital elements for further developments in quality. No single element is the Holy Grail; it is the combination of all five that will bring success.