status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 55
In these countries the working conditions are usually more favourable for the general
practitioners than in Belgium. The practice infrastructure includes nearly always
personnel who perform medical acts or help with organisational issues. There is a
strong IT infrastructure. Those conditions support the implementation of quality
initiatives. The quality development either relates to remuneration (UK) or to the need
for doctors to have data for comparison with colleagues (Australia and Germany) or
both (the Netherlands).
Implementing a quality development system implies a comprehensive strategy with the
following six important domains, as adapted from the Australian example:
• Professional values within the group of GPs: the intrinsic values and driving
forces to increase the quality of care;
• Empowering the patient’s role in quality;
• Improving competences: the GPs should have training on quality
development. The basic assumptions of quality development should be core
values of the profession. A support to practice quality development besides
patient care is necessary;
• Capacity: GP practices should be organised to handle the workload as general
practice covers a broad range of needs. People need rapid and safe care for
acute and emergency situations, well organised care for ongoing complex
conditions, empathic and supportive care for special needs;
• Improving the knowledge and information management in the practice is
essential to set up quality initiatives. Performing IT systems are important;
• Financing is a necessary condition for developing quality initiatives.
The appendix 12 gives a possible illustration that relates to flu vaccination.
The following conclusion can be drawn from this literature search:
• Until now, the accreditation scheme in Belgium did not show to lead to
any measurable improvement in quality;
• In Belgium, the quality development at the GP practice level is missing;
• The successful countries analyzed in this report have a finely tuned
approach towards quality development (e.g. the combination of different
elements as a framework, a legislation, different stakeholders,
involvement of the profession);
• A good organization in the practice (e.g. IT infrastructure, personnel) is a
prerequisite for the successful implementation of quality initiatives;
• The Dutch and Australian examples give an estimation of the minimal
budget needed for a practice based quality development system i.e. from
1 to 5 euros per inhabitant per year;
• A quality development system offers a better visibility and accountability
of general practice to the public and stakeholders.
4.3 10 ELEMENTS FOR A QUALITY FRAMEWORK IN BELGIUM
A former KCE project developed a framework for a quality system in Belgium (see
appendix 11). The first step is the definition of a quality policy i.e., “a formal statement
by the government that encompasses the necessary strategies to achieve the health
objectives as determined by the policy makers and society”. Within the quality policy, a
quality indicator system should be a core initiative where data on a number of quality
indicators are systematically collected, summarized and used for feedback to the
stakeholders.
The following diagram and paragraphs illustrate how elements specifically interact to
build up a quality development system in general practice.