Quality in health care: "It is about the welfare of treated patients"

Interview with Dr. Karsten Neuman, IGES Institut GmbH

Measuring quality in health care is not easy. Controlling it doesn’t just provide challenges for the medical sector, but also for policy makers. This is why measuring and representation systems for quality in hospitals as well as improvement concepts are being developed at the IGES Institute.


Photo: Man with gray-streaked hair and striped suit - Karsten Neumann

Dr. Karsten Neumann; ©IGES Institut GmbH

In a study conducted by the Institute on behalf of the German Health Insurance Alliance VDEK (German: Verband der Ersatzkassen e.V.), IGES shows several solutions from abroad and suggests how they could be implemented in Germany. MEDICA.de looks at the bigger picture with Managing Director Dr. Karsten Neumann and talks about solutions that always keep the welfare of patients in mind.

Dr. Neumann, how do you define quality in health care?

Karsten Neumann: The health economic approach differentiates between structure, process and outcome quality. Outcome quality is particularly important; that being the outcome of a medical measure. Yet there are also other aspects that quality measurement currently considers less, but a patient definitely ponders before he/she chooses a hospital or service. When you choose a hospital, the proximity or the institution can also play a role. And those, who don’t like shots for instance, might choose pills instead. Patient-relevant aspects are also increasingly considered in quality measurement.

How is quality measured and controlled in Germany?

Neumann: Currently a lot is being measured at the inpatient level. Quality measurements have been conducted for more than ten years in this area. The result is more than 430 quality indicators that represent about 20 percent of performance in health care. So we have excellent quality data available. However, subsequent necessary control is lacking.

The measurements are not actually contributing to quality?

: Unfortunately, things don’t look so good when it comes to control, because we don’t utilize the data enough. There is one tool for hospitals, the so-called structured dialogue process, where hospitals are approached about noticeable problems, new goals are being set and solutions and explanations are sought after. However, this is not a sharp instrument and usually has no consequences.

Much of the measured data is published on the Internet – there is the hospital browser (German: Kliniknavigator) by the AOK insurance company for instance or the Whitelist (German: Weisse Liste). Why are they being used so infrequently?

: On the one hand, this data is often very hard to understand for laypersons. The hope that patients would go by these quality measurements has so far barely come true. On the other hand, hospitals definitely know and are able to read from their own data where a hospital delivers good or bad quality. However, they are not allowed to draw any conclusions from it. Quality measurement therefore rarely or never leads to changes at the institutional level.
Photo: Patient with a walking aid in the hospital

In Germany quality in health will be often measured. However, the data could be much better used for its control; ©panthermedia.net/ auremar

Is the reason for this perhaps the lack of staff?

: It is more the lack of political will, because if we take this seriously this has implications for the hospital structure of course. When you steer patients to where good results are being achieved, suddenly the ward at another hospital is empty. And people are afraid of these consequences. However, this is about the welfare of the treated patients, which is why this fear cannot be tolerated.

Which international standards could Germany model itself after to improve the quality in its hospitals?

: Let me begin by emphasizing that our hospitals render excellent services. However, this differs greatly by region. This is why we looked at the bigger picture in this study and mentioned a few examples from abroad where quality in health care is better controlled. Two factors stood out: first, these countries put a lot of effort into measuring and comparing quality. Secondly, they are not afraid to publish the data and make it clearer and more understandable for patients.

What’s more, there often is more self-criticism in health care in other countries. The Departments of Health in the Netherlands and Canada for instance regularly check quality indicators and publically compare them to the results of other countries. This kind of critical reflection is important to find out where and how things can be improved.

What concept does the IGES Institute recommend?

: Initially we need minimum quality standards based on the existing indicators in inpatient care. Subsequently, our concept identifies those hospitals that fall short. They would then have the opportunity to improve within a certain timeframe. If the desired standard nevertheless has not been achieved, the given service should no longer be performed in this hospital. In the case of extremely poor results, an immediate license revocation for a specific service should be possible.

This way, hospital facilities would specialize in individual services.

: This can happen, but it should be well balanced. When you take away service from the worst hospitals, it needs to be provided elsewhere. This is why the best hospital facilities should have the opportunity to conclude selective contracts with health insurance companies. Therefore, the quantity of health services is not actually meant to be affected at all. This is all about the welfare of the patient, who subsequently can only receive great care.
Foto: Michalina Chrzanowska; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Michalina Chrzanowska and translated by Elena O'Meara.