Promoting good medical care

  • Borman E
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This paper sets out the policy of the Union Européenne des Médecins Spécialistes/European Union of Medical Specialists (UEMS) on quality assurance (QA), which is defined here as the regular review against defined standards of medical care. Its aim is to provide a framework for confirming the good quality of health care in Europe and, specifically, of the contribution of specialist doctors. The paper provides guidelines that can be adopted for use in QA systems in all European countries. It will show that this can best be achieved when QA is based on valid evidence, which can also facilitate improvements in medical care and justify the provision of necessary resources. This UEMS policy paper builds upon considerable evidence of successful, well-established QA systems that are found in many parts of Europe. Fundamental features of these are that they are led by specialist doctors who control resources allocated solely for the purpose of QA. Accordingly, the UEMS recognises its responsibility to develop policy based on this experience and invites all interested parties to support this. The UEMS considers QA to be an essential component of an agenda focused on high standards of medical practice. The other parts of that agenda include continuing professional development as a form of quality improvement-covered separately in the 2001 UEMS policy document "The Basel Declaration"-and its policy being developed on regulating the medical profession. This paper is addressed to all who have an interest in the quality of health care provision: patients, doctors, medical associations, health service employers and hospitals, fund holders, regulatory authorities and national and European legislators. The UEMS considers that, in the context of the QA of medical care, all share the following agenda:of ensuring that systems for assuring the good quality of medical care are appropriately monitored, supported and funded;of working together, within a medically led structure to achieve continuing improvement in the quality of care;that the means of achieving the above is through the implementation of a QA system that considers all relevant components: the individual doctor, the team(s) within which they practice and their work environment;that this system should be based on the QA cycle: monitoring medical care against standards accepted as medically valid, introducing improvements that are appropriately resourced, reviewing these changes and ensuring that the system itself is adequately quality assured. The UEMS draws attention to the lack of evidence demonstrating any additional effectiveness of mandatory systems over the model described here. The following list of key points drawn from the text expands this summary. It also serves as an index to specific paragraphs of the paper. All groups interested in the quality of health care must acknowledge their own and other groups' responsibilities to support high standards of medical care (3, 8-11).Professional standards must continue to be revised to match changing expectations, technologies and resource availability (9).To be effective, a QA system must consider all relevant components: the individual doctor, the team(s) within which they practice and their work environment (23, 26-36).QA systems must be designed around outcomes and methodologies that have the confidence of all interested groups (24-25).If they are to be accepted for implementation, the setting of standards requires a solid evidence base, to be medically led and a high degree of consensus (13-15, 24).Valid measures of performance-a term that reflects all components of a doctor's practice-are required for valid QA (16-17).Appropriate consideration must be given to the many variables that may affect measured outcomes of medical care (18-21, 31, 34).All specialist doctors should engage in a suitable QA process organised by the medical profession to confirm the quality of their clinical care and their continuing fitness to practice (22).The confidentiality of data, personal to patients and doctors, must be respected (25).External audit by trained peer assessors following defined criteria is a well-validated means of assuring and promoting the quality of the work environment and health care teams (26-30).Internal audit and peer review are well-validated means of assuring and promoting the quality of health care teams and individual doctors (29-32).Risk management systems covering all three functional levels-work environment, health care team and individual doctors-can assist whole organisations to improve their safety and quality of care. This requires open reporting in a "no blame" culture (33-35).It is an absolute requirement for a QA system to be supported by appropriate resources. These include time, people, money and information technology (36).QA systems must have a protected budget and be financially accountable (37-39).The UEMS recommends a workable model based on the QA cycle for confirming and promoting the good quality of medical care. It includes all relevant interest groups, emphasises the setting of valid outcome measures and the monitoring of all three relevant functional levels, encourages developmental interventions, including with regard to "outliers" and is itself subject to regular review (40-47).The UEMS draws attention to the lack of evidence demonstrating any additional effectiveness of mandatory systems (47). © 2004 Published by Elsevier B.V.

Author-supplied keywords

  • Health care
  • Quality assurance
  • UEMS

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  • Edwin Borman

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