Impact and results of quality improvement and patient safety programmes in hospitals : HAS studies and projects
The last decade has seen an unprecedented rise in the development and implementation of quality and safety improvement initiatives in health care, both in France and abroad, as awareness of medical errors and variation in clinical practice and quality has grown. This has resulted in the introduction of improvement programmes nationwide, including hospital accreditation, professional practice appraisal, and accreditation of doctors in high-risk specialties.
However, given the significant public and professional investment in these health care quality and safety improvement initiatives, evaluation of these programs is essential. HAS is currently assessing the impact of quality improvement systems to determine their effectiveness, the factors driving practice and organizational change, and where they should go next. This appears to be a necessary and crucial step to (re)design strategies that will engage the professionals, disseminate quality and safety culture and impact positively on the quality of care.
These efforts have included :
- Studies to assess the impact of accreditation of hospitals ;
- A scheme for global monitoring of the quality of services in hospitals, by introducing national indicators for certain key sectors ;
- Leadership and support for a movement led by health professionals to assess the clinical impact of improvement programmes. One manifestation of this movement is a joint publication by HAS and the British Medical Journal (BMJ) summarising the contributions of many French teams.
In 2011, HAS is stepping up these actions by publishing a number of reports on the impact of improvement initiatives in hospitals, including :
A literature review on the impact of accreditation of hospitals, carried out by Matrix Insight :
The IMGENI study, carried out by the Centre for Organisational Sociology (CSO, Sciences Po) and Institute for training and research in organisations in healthcare and social sector (IFROSS) and coordinated by the Aquitaine Committee for Coordination of Clinical Assessment and Quality (CCECQA), on the implementation of the national quality indicator programme in the Aquitaine region :
The 2009-2010 report on HAS’ quality indicator results :
A literature review by Béatrice Fermon and Pierre Lévy (Laboratoire d’Economie et de Gestion des Organisations de Santé, Université Paris-Dauphine) on public reporting of performance indicators :
HAS at the heart of a European research project
HAS and the CCECQA (Comité de Coordination de l’Evaluation Clinique et de la Qualité en Aquitaine) are the coordinating bodies for hospital involvement and data collection in France for “Deepening our Understanding of Quality Improvement in Europe” (DUQuE), a major EU funded research project. From November 2009 to April 2013, DUQuE aims to study the effectiveness of quality improvement systems and their impact on patient level outcomes. It will explore whether the quality efforts in our hospitals and hospital departments are associated with better results in terms of clinical, patient safety and patient reported outcomes. Data collection is carried out using various methods in hospitals from 8 countries in Europe.
For more information
- Symposium HAS - BMJ : Clinical impact of quality improvement (Impact clinique des programmes d'amélioration de la qualité) - Nice, 19th April 2010
- The ISQua - The International Society for Quality in Health Care
- DUQuE (Deepening our Understanding of Quality Improvement in Europe)
- Cochrane Effective Practice and Organisation of Care Group
- Impact des dispositifs d'amélioration de la qualité et de la sécurité des soins dans les établissements de santé
- To provide information for the public and generally improve the quality of medical information
- Résumé de l'article COMPAQH : Minvielle E, Leleu H, Capuano F, Grenier C, Loirat P, Degos L. Suitability of three indicators measuring the quality of coordination within hospitals. BMC Health Services Research 2010, 10: 93