[Event Report] The 53rd Breakfast Meeting: -Quality Indicator, Measuring Quality of Healthcare
date : 6/12/2015
Tags: HGPI Seminar
Theme: Measuring Health Care Quality: Quality Indicators
Speaker: Dr. Tsuguya Fukui, President of St. Luke’s International Hospital
Date: May 20, 2015
Venue: Kobeya Sylphide, GranAge Marunouchi
On May 20, 2015, HGPI hosted a breakfast meeting featuring Dr. Tsuguya Fukui, the president of St. Luke’s International hospital and a lead figure in the development of St. Luke’s International Hospital’s quality indicators (QI), which were created in 2007 and gained international recognition after being cited in a 2014 OECD report, Reviews of Health Care Quality: Japan.
– Summary –
Improving Health Care Quality through the use QI: St. Luke’s International Hospital’s approach
■Examples of QI in Use at St. Luke’s International Hospital
When treating patients with hypertension, the patient’s blood pressure is monitored not only by the attending physician, but by all others in the hospital who interact with that patient to improve blood pressure control by monitoring the rate of blood pressure decrease. Because there is a significant number of patients with hypertension, consultations by these patients are not limited to specialists, but include non-specialists as well. Each practitioner has access to the blood pressure measurements and study sessions are held. For those patients whose health outcomes do not improve as expected, an alert appears on the electronic medical record.
The same process takes place with patients with diabetes whose HbA1c values shared with attending physicians. Physicians are able to see what medicines have been prescribed by checking electronic medical records. Data is then utilized during consultations with specialists and during study sessions to better understand the most appropriate treatment for patients.
The use of QI has led to a decrease in the incidence of catheter insertion complications. By inviting outside speakers to give lectures, providing staff trainings, using an authorization system, we have been able to drastically reduce the number of complication cases.
Hand hygiene, which helps to prevent hospital-acquired infections, has also greatly improved. It began with direct observation by a supervisor and moved onto monitoring with use of video cameras. Eventually, 24-hour surveillance cameras were installed to monitor activities across the hospital. Using this surveillance system, we are able to give feedback and engage in discussions on the challenges of handwashing with medical personnel who fail to maintain hand hygiene. As hand hygiene has improved, the rate of infections has decreased.
■ QI Benchmarks and PDCA cycle
The provision of high-quality healthcare to all patients of St. Luke’s International Hospital is the responsibility of the president. QI is summarized into books available to all hospital staff and most indicators have improved as a result. Staff is motivated by other physicians and hospitals who are working to improve using QI and the Hawthorne Effect (being observed leads to improved performance) plays a role as well. Using the PDCA cycle in the medical workplace is also important and effective.
■ Expanding throughout Japan
The concept of QI is continuing to expand. The Japan Hospital Association’s implementation of a program called the QI Project is one example of a major step forward. When the QI Project began, there were 30 participating hospitals. Year by year the number of participating hospitals has grown and currently there are 326 hospitals taking part in the project. The analysis of the data gathered through the QI Project takes place mainly at the St. Luke’s International Hospital. Using benchmarks for each participating hospital, the hospitals are given feedback. Case study presentations are also held so that others can learn from successful cases.
■QI in the International Context
In other countries, we see health care quality indicators being tied to compensation. The US is using pay for performance and the UK is implementing similar incentive systems. In France and the Netherlands, QI is widely used to rank hospitals although it is not tied to compensation.
QI is not appropriate for all the cases. For example, hospitals with unfavorable QI values tend to have a large number of emergency patients. Therefore, QI cannot be evaluated on the basis of values alone; hospitals’ unique settings and the risks they face must also be considered. It is critical to introduce QI at the appropriate hospitals and utilize it to improve and modify behavior within those hospitals.
In March 2014, the OECD ranked Japan 12th among OECD countries. The OECD’s November 2014 report cited the QI Project taking place at St. Luke’s International Hospital’s as significantly impressive and as a potential model for the rest of the country. We hope to continue to contribute to the world.
* OECD Reviews of Health Care Quality: Japan
Registration deadline: 2015-05-18
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