status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 57
Ten key issues can be identified for developing the framework. All stakeholders need to
be involved in the development and the validation process of this framework in order to
achieve success. The German and UK examples learn that legislation coupled with
specific financial incentives is a powerful stimulus.
4.3.1 Need for professional culture change
The GPs should continuously bear in mind the importance of quality improvement
principles when performing their daily work. GPs should become familiar with the
concepts of quality development, measurement of indicators and the use of the quality
cycle.
The involvement of GP opinion leaders and scientific bodies is the most critical
precondition to succeed in quality development initiatives at the individual, practice,
regional and national levels. Australia is the most outstanding example of the power of
the profession to launch effective quality programs. Opinion leaders of general practice
in the UK, Australia and the Netherlands closely interact with the academics. The GP
opinion and scientific leaders in these countries outlined the concepts of the quality
development programmes and subsequently marketed these to the professional bodies.
In Belgium, academic departments and scientific bodies also have to take up their
position in the quality debate. They must define the content of the quality initiatives and
how the profession will achieve their successful implementation.
4.3.2 Health Authorities in a future quality system
The role of the Health Authorities is first to address a quality policy that deals with
priority aspects and anticipates the different steps from data collection to the use of
results for further improvement. Authorities must also define the tools that should be
promoted for quality improvement in general practice. The choice of the most
appropriate tools must adhere to the scientific literature and experience from other
countries, as described in this report.
A very powerful drive for change is a legal framework that introduces the requirements
for quality development. The UK and Dutch professional bodies have referred to
implicit thread of formal regulations on quality. The UK and Australia are successful
illustrations of the need for a pre-existing legal framework. The consequences of
registration of data for quality measurement will be clearly determined beforehand.
Political will and leadership are needed to put the development of quality in general
practice on the political agenda, including the specification of a time frame in which
general practice should adhere to a quality development scheme.
Furthermore the Authorities have a facilitating role:
• To support a platform that will collect the data and to create an independent
trustworthy body that will provide feedbacks to the GPs and stakeholders;
• To promote and financially support standardised IT equipment that allows the
collection of routine data for the measurement of quality indicators.
4.3.3 Stakeholders
All countries that have adopted successful quality development strategies have a finely
tuned interaction between the key groups influencing the choice of quality measures i.e.
purchasers, patients and physicians. 17 For Belgium the following stakeholders could take
part in quality development i.e., general practitioners, scientific GP bodies, regional
organisations of general practice, academic departments of general practice, other
organisations of primary health care like nursing and regional multi-professional bodies,
GP unions, sickness funds and the Intermutualistic agency (IMA/AMI), INAMI/RIZIV,
organisations of patients and software suppliers.