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The Stuttgart-Heidelberg Model of Active Feedback Driven Quality International Journal of Clinical and Health Psychology ISSN: 1697-2600 [email protected] Asociación Española de Psicología Conductual España Kordy, Hans; Bauer, Stephanie The Stuttgart-Heidelberg Model of Active Feedback Driven Quality Management: Means for the Optimization of Psychotherapy Provision International Journal of Clinical and Health Psychology, vol. 3, núm. 3, septiembre, 2003, pp. 615-631 Asociación Española de Psicología Conductual Granada, España Available in: http://www.redalyc.org/articulo.oa?id=33730311 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Revista Internacional de Psicología Clínica y de la Salud/ ISSN 1576-7329 InternationalKORDY and Journal BAUER. of Clinical Stuttgart-Heidelberg and Health Psychology Model 2003, Vol. 3, Nº 3, pp. 615-631615 The Stuttgart-Heidelberg Model of Active Fee- dback Driven Quality Management: Means for the Optimization of Psychotherapy Provision1 Hans Kordy2 and Stephanie Bauer (Center for Psychotherapy Research Stuttgart, Germany) (Recibido 3 enero 2003 / Received January 3, 2003) (Aceptado 30 abril 2003 / Accepted April 30, 2003) ABSTRACT. Quality management deals with the evaluation of psychotherapeutic treatment. A central aspect concerns the development of appropriate assessment batteries and evaluation criteria. The Stuttgart-Heidelberg (S-H) model represents a system providing concepts, psychometric tools and a computer software, developed for the purpose of active feedback driven quality management. The key information of the Stuttgart-Heidelberg Model is on the outcome of the individual treatment. The assumption is that psychotherapeutic care can be improved by providing information on shortcomings of the delivered care to practitioners, because problem solving processes will be stimulated by the feedback. The present contribution introduces the assessment inventory, the standardized outcome evaluation and the different feedback tools of the S-H model. A systematic study including 1715 patients from a psychosomatic hospital documents the validity of the approach. The empirical findings encourage the call for transparency about what happens in clinical routine – i.e. about the applied treatments, their results and their costs. Implications for further optimization of health care provision are discussed. KEYWORDS. Stuttgart-Heidelberg Model. Outcome evaluation. Feedback. Quality management. Psychotherapy service provision. 1 This research was funded in part by grant number Ko 1109/4-1 from the Deutsche Forschungsgemeinschaft DFG (German Research Foundation). We wish to thank the Panorama Fachklink für Psychosomatik und Psychotherapie, Scheidegg/Allgäu (Dr. C. P. Dogs) for their contribution of data. 2 Correspondence: Center for Psychotherapy Research Stuttgart. Christian-Belser-Strasse 79a. D-70597 Stuttgart (Germany). E-mail: [email protected] RIPCS/IJCHP, Vol. 3, Nº 3 616 KORDY and BAUER. Stuttgart-Heidelberg Model RESUMEN. La gestión de la calidad busca la evaluación del tratamiento psicoterapéutico. Un aspecto central se relaciona con el desarrollo de baterías de evaluación y criterios de evaluación adecuados. El modelo Stuttgart-Heidelberg (S-H) representa un sistema que pro- porciona conceptos, instrumentos psicométricos y un programa informático desarrollado para la gestión de la calidad basada en el feedback activo. La información central del modelo Stuttgart-Heidelberg es el resultado individual del tratamiento. El planteamiento es que la psicoterapia puede mejorarse si proporcionamos información sobre los resultados terapéuti- cos (en especial los negativos), pues los procesos de solución de problemas se estimularán por el feedback recibido. El presente trabajo presenta un inventario de evaluación, la evalua- ción estandarizada de los resultados y las diversas herramientas de feedback del modelo S- H. Un estudio sistemático incluyendo 1715 pacientes de un hospital especializado en trastor- nos psicosomáticos documenta la validez de este abordaje. Los resultados empíricos refuer- zan una estrategia de transparencia acerca de lo que acontece en la práctica clínica – por ejemplo, acerca de los tratamientos administrados, sus resultados y costos. Implicaciones para la pos- terior optimización de los servicios de salud son discutidos. PALABRAS CLAVE. Modelo Stuttgart-Heidelberg. Evaluación de resultados. Feedback. Gestión de calidad. Servicios de psicoterapia. RESUMO. A gestão da qualidade lida com a avaliação do tratamento psicoterapêutico. Um aspecto central relaciona-se com o desenvolvimento de baterias de avaliação e critérios de avaliação adequados. O modelo Stuttgart-Heidelberg (S-H) representa um sistema que fornece conceitos, instrumentos psicométricos e um programa de computador desenvolvido para a gestão da qualidade baseada no feedback activo. A informação central do Modelo Stuttgart-Heidelberg é o resultado individual do tratamento. O pressuposto é o de que a psicoterapia pode ser melhorada se fornecermos informação acerca dos resultados terapêuticos, especialmente os negativos, pois os processos de solução de problema serão estimulados pelo feedback recebido. A presente contribuição apresenta um inventário de avaliação, a avaliação estandardizada dos resultados e as diversas ferramentas de feedback do modelo S-H. Um estudo sistemático incluindo 1715 pacientes de um hospital especializado em doenças psicosomáticas documen- ta a validade da abordagem. Os resultados empíricos encorajam uma estratégia de transparência acerca do que acontece nas rotinas clínicas – i.e. acerca dos tratamentos administrados, os seus resultados e custos. Implicações para posterior optimização dos serviços de cuidados de saúde são discutidos PALAVRAS CHAVE. Modelo Stuttgart-Heidelberg. Avaliação dos resultados. Feedback. Gestão da qualidade. Serviços de psicoterapia. Introduction: Quality management in psychotherapy provision Psychotherapy looks back on a successful history - and forward to an exciting future. Close co-operation between researchers and clinicians – often combining these orientations in person – made this successful development possible. Clinicians challenged researchers by clinical questions and research findings stimulated clinicians to try out new things and to raise new questions. Numerous studies demonstrated the efficacy of psychotherapy RIPCS/IJCHP, Vol. 3, Nº 3 KORDY and BAUER. Stuttgart-Heidelberg Model 617 (cf. e.g. the overviews by Grawe, Donati, and Bernauer, 1994; Lambert and Bergin 1994, Shadish, Navarro, and Crits-Crhistop, 1997; Smith, Glass, and Miller 1981) and created a sound base of evidence (e.g. Roth and Fonagy 1996). This made psychotherapy a recognized part of the health care system in many countries. Obviously, psychotherapeutic services meet the demand of many people, when they or their relatives need therapeutic help as the impressive satisfaction rates demonstrate (e.g. Hannöver, Dogs, and Kordy, 2000). Being a regular part of the health care systems implies shared responsibilities with all other segments: “As responsible professionals, therapists must learn to think critically and scrutinize the quality of their professional activities and the therapeutic product. This has always been the hallmark of mature profession” (Strupp and Howard 1992). FIGURE 1. Evaluation and quality management in the innovation process. Invention Innovation Diffusion Time Figure 1 describes this development from a general perspective (Sachverständigenrat für die Konzertierte Aktion, 1995). The innovation phase came to the end during the eighties. This was followed by the diffusion phase, i.e., by extension of service provision for various purposes by an increasing number of providers. The current phase is still characterized by diffusion, but more and more saturation has to be taken into consideration. As explained by the schema evaluation gets an important steering role for the transition from the innovation to the diffusion phase in deciding whether an innovative service alternative allows to achieve the given objectives with reasonable effort. The great number of evaluation studies of psychotherapy during the seventies and eighties corresponds with this (e.g. Kordy and Kächele 1997; Strupp and Howard, 1992). In approaching the level of saturation the attention shifts to quality assurance. Correspondingly the number of RIPCS/IJCHP, Vol. 3, Nº 3 618 KORDY and BAUER. Stuttgart-Heidelberg Model publications on developing and testing models of quality assurance increased during the nineties. Quality management and outcome orientation are considered as efficient tools for the optimization of service provision. The expectation is that full transparency about what happens in everyday clinical practice will open up new ways of systematic learning for all who can contribute to the optimization, i.e. the therapists (providers) and the patients (consumers) as well as health care managers, health insurance managers, and health politicians. The Center for Psychotherapy Research in Stuttgart started an initiative in the early nineties. Together with clinical partners from the Psychiatric Institute of the University of Heidelberg the Stuttgart-Heidelberg Model of Active Internal Quality Management was developed (Kordy 1992; Kordy and Lutz, 1995; Kordy, Hannöver, and Richard, 2001; Lutz, Stammer, Leeb, Dötsch, Bölle,
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