[Quality management according to DIN EN ISO 9001 at a university eye hospital]

[Jury prize of the Austrian National Prize 2018 : 12 years European Foundation for Quality Management (EFQM) at the University Eye Clinic Graz]

Fragestellung

Kann sich ein Non-Profit-Unternehmen wie eine Universitäts-Augenklinik in Konkurrenz zu Profit-Unternehmen erfolgreich für einen Staatspreis des Bundesministeriums für Innovation und Wirtschaftsstandort in Österreich bewerben.

Material und Methode

Nach erfolgreichen Committed to Excellence (C2E) Assessments 2008/2010 wurde ein 70-seitiger Unternehmensbericht streng nach der EFQM(European Foundation for Quality Management)-Logik (bestehend aus Grundkonzepten, Kriterienmatrix und RADAR-Logik) erarbeitet. Im Assessment 2018 wurde besonderes Augenmerk auf die Entwicklung der Strategie der Universitäts-Augenklinik mit ihren beiden Anteilseignern (Shareholdern), der im Besitz des Landes Steiermark befindlichen Krankenanstalten Gesellschaft (KAGes) und der dem Bundesministerium zugehörigen Medizinischen Universität Graz, gelegt und diese mithilfe der X‑Matrix (nach Hoshin-Kanri) entwickelt und dargestellt.

Ergebnisse

Das Gesamt-Punktescore im Recognised for Excellence(R4E)-Assessment 2018 war 500 bis 550 Punkte, was die Jury zur Vergabe eines Jurypreises des Österreichischen Nationalpreises (Fokus: partizipative Führung) veranlasste. Verbesserungspotenziale waren die Ausrichtung der Kernprozesse auf die Hauptleistungsindikatoren der Universitäts-Augenklinik, die sich aus ihrer Mission, bestehend aus Patient*innen Versorgung, Forschung, Lehre, Ausbildung und Öffentlichkeitsarbeit, ergeben. Die Entwicklung der Strategie mit den Anteilseignern hat sich gegenüber dem R4E-Assessment von 2017 von einem Potenzial zu einer Stärke entwickelt.

Diskussion

Schriftliche und mündliche Rückmeldungen aus einem EFQM-Assessment sind der größte Mehrwert („value-added“) aus diversen Preisbewerbungen für eine Universitäts-Augenklinik sowie allgemein für Wirtschaftsunternehmen.

[Quality Management at the Eye Centre of Freiburg University Hospital: Does it Help to Use Quality Parameters?]

BACKGROUND

All hospitals in Germany have a legal obligation to carry out internal quality management (QM). This means enormous costs as well as a burden for the employees through QM-specific tasks. The benefits can be advertising through certification, higher quality and safety for the treated patients and thus greater patient and employee satisfaction. The aim of this work is to compare effort and benefit of a QM system in ophthalmology.

MATERIAL AND METHODS

The surgical quality parameters already published in the annual reports, the available data of the QM handbook via the digital QM portal and patient feedbacks from 2004 to 2018/2019 were evaluated.

RESULTS

In 2004, a quality management system was established for the first time in the Eye Centre at the Freiburg University Hospital. From 2005 to 2017, the entire hospital was KTQ-certified. In order to analyse the quality of surgery and patient safety, different surgical quality parameters were collected over the years with a constantly increasing number of operations. The majority of the quality parameters have remained stable or even decreased over the years. A peak in the postoperative endophthalmitis rate of 0.14% in 2015 and the decreasing percentage of cataract operations under topical anaesthesia in recent years were striking. The QM handbook was slimmed down. The analysis of clicks shows that the documents are increasingly used by the employees. The statistics of patient feedbacks show that this is a tool that is used quite frequently by patients to provide feedback on their stay and that the feedback is often positive.

CONCLUSION

To operate quality management over many years, i.e. in our case to collect data of surgical quality parameters, to maintain the QM manual and to process patient feedbacks, means considerable effort. However, only the analysis of these parameters provides an insight into the current state of our clinic, from which conclusions can be drawn as to where processes or treatments can be optimised, which in turn can increase employee and patient satisfaction. Overall, transparency is increased and creates confidence for future treatments at the Eye Centre at the Freiburg University Hospital.

ISO 9001 certification for hospitals in Bulgaria: does it help service?

The aim of our study is to review the published literature on establishment and implementation of ISO 9001 QMS in European hospitals, to study the availability of International Organization for Standardization (ISO) quality management systems (QMS) in Bulgarian hospitals and to outline the main advantages of ISO implementation in the hospitals in Bulgaria. The information on availability of ISO QMS in the hospitals in Bulgaria was gathered via Bulgarian certification register, the registries of various quality associations, websites of hospitals and certification companies presented in Bulgaria. A total number of 312 hospitals in Bulgaria were screened for the availability of QMS certified against the ISO 9001 requirements. The experience of European hospitals that implemented QMS is positive and the used approaches to improve the processes and the demonstrated effects from ISO implementation are analysed by the researchers. Unlike other European Union member states, the establishment of quality management systems in Bulgaria is not compulsory. However, our study revealed that 14.42% of the hospitals in Bulgaria have implemented and have certified quality systems against the requirements of ISO 9001. Our study confirmed that a quality management system using the ISO 9001 standard is useful for the hospitals as it can help to increase the operational efficiencies, to reduce errors, improve patient safety and produce a more preventive approach instead of a reactive environment.

[Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz]

BACKGROUND AND OBJECTIVE

In the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3 years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely "Committed to Excellence (C2E)". The project work towards achieving this C2E-award is described below.

STUDY DESIGN AND METHODS

EFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology.

RESULTS

These areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria.

DISCUSSION

The EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.

[Quality assurance in student training. Prerequisites for DIN EN ISO 9001:2000 in teaching]

Standards of quality assurance according to DIN EN ISO 9001:2000 have been implemented in many university hospital departments, but often teaching activities are not included. This work presents a method that allows, after having defined the various teaching activities as sub-processes of one single core process, to include the manifold teaching activities of university hospital departments into the certification process. The stepwise description of the prerequisites for including teaching activities into ISO 9001 certification is illustrated by a concrete implementation example.

[Conceiving and implementing an ISO 9001:2000 quality management system: quality improvement and efficiency increase over 3 years at the Dept. of Ophthalmology, Sultan Qaboos University in Oman]

BACKGROUND

Oman is a developing country of the Middle East with a University Hospital in a national health system. Problems related to documentation, structure, and procedure prevailing in a multicultural environment result in a lack of productivity. The aim of this study was to test the feasibility of introducing a quality management system according to ISO 9001:2000 into a university department of ophthalmology with special reference to quality and efficiency data over 3 years.

MATERIALS AND METHODS

Standardized types of documentation (35 documents, 183 forms and formats, and 453 registers) under a formal roof (booklets for work instructions, quality management, procedures) were conceived in 2001 and implemented, and were evaluated by descriptive statistics over the years 2002-2005 with respect to quality and efficiency. In 2005, the departmental QMS was merged into the QMS of the whole hospital.

RESULTS

Establishment of "responsibility clusters" with structured surveillance tasks, procedural improvements, and continuous audits resulted in a significant quality improvement already during the implementation until ISO 9001:2000 certification in 2002, and over the following 3 years. The data were assessed by non-conformities documented monthly (total inpatients: -50%, outpatients: -20%, operating theater: -100%, teaching: -10%; p <0.05) and increased efficiency assessed by the most important performance indicators (before QMS vs a median of 3 years with QMS): major surgery: +459%, inpatient stay: -49.7%, occupancy rate: +63.9%, technical diagnostics: +292.9%, postgraduate teaching total: +740%, research output total: +330% (p <0.05).

CONCLUSIONS

It is feasible to introduce the quality management system according to ISO 9001:2000 into a developing country in the Middle East. It has an immediate effect on the increase of efficiency (measured by performance indicators) and quality in all systems providing the possibility for regional benchmarking.

[Quality management in ophthalmology. Putting it into practice in the clinical routine]

Though quality assurance has been an integral part of modern patient care for many years, this topic has gained in importance in German health policy. The introduction of a new reimbursement system for inpatients according to diagnosis-related groups (DRG) as well as the continuous cutbacks in public financial resources in the German health system raise concern that the quality of patient care will decline. To prevent this, comprehensive quality assurance measures as well as the implementation of professional quality management systems in German healthcare organizations are required by law (Section 135-137 SGB V). In the following, generally accepted concepts and methods of quality management are described.