Cover_WHO_nr52.qxp_Mise en page 1 20/08/2019 16:31 Page 1 51 THE ROLE OF PUBLIC HEALTH ORGANIZATIONS IN ADDRESSING PUBLIC HEALTH PROBLEMS IN EUROPE PUBLIC HEALTH IN ADDRESSING ORGANIZATIONS PUBLIC HEALTH THE ROLE OF Quality improvement initiatives take many forms, from the creation of standards for health Improving healthcare 53 professionals, health technologies and health facilities, to audit and feedback, and from fostering a patient safety culture to public reporting and paying for quality. For policy- makers who struggle to decide which initiatives to prioritise for investment, understanding quality in Europe Series the potential of different quality strategies in their unique settings is key. This volume, developed by the Observatory together with OECD, provides an overall conceptual Health Policy Health Policy framework for understanding and applying strategies aimed at improving quality of care. Characteristics, effectiveness and Crucially, it summarizes available evidence on different quality strategies and provides implementation of different strategies recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies. Edited by Quality of care is a political priority and an important contributor to population health. This Reinhard Busse book acknowledges that "quality of care" is a broadly defined concept, and that it is often Niek Klazinga unclear how quality improvement strategies fit within a health system, and what their particular contribution can be. This volume elucidates the concepts behind multiple elements Dimitra Panteli of quality in healthcare policy (including definitions of quality, its dimensions, related activities, Wilm Quentin and targets), quality measurement and governance and situates it all in the wider context of health systems research. By so doing, this book is designed to help policy-makers prioritize and align different quality initiatives and to achieve a comprehensive approach to quality improvement. The editors Reinhard Busse, Professor, Head of Department, Department of Health Care Management, Berlin University of Technology and European Observatory on Health Systems and Policies and Berlin University of Technology Niek Klazinga, Head of the OECD Health Care Quality Indicator Programme, Organisation for Economic Co-operation and Development, and Professor of Social Medicine, Academic Medical Centre, University of Amsterdam Dimitra Panteli, Senior Research Fellow, Department of Health Care Management, Berlin University of Technology Wilm Quentin, Senior Research Fellow, Department of Health Care Management, Berlin University of Technology OECD ISBN OECD Health Policy Series No. 53 www.healthobservatory.eu Observatory ISBN Observatory Improving healthcare quality in Europe Characteristics, effectiveness and implementation of different strategies The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The Observatory is a partnership hosted by the WHO Regional Office for Europe, which includes other international organizations (the European Commission, the World Bank); national and regional governments (Austria, Belgium, Finland, Ireland, Norway, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy); other health system organizations (the French National Union of Health Insurance Funds (UNCAM), the Health Foundation); and academia (the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM)). The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Technical University of Berlin. Improving healthcare quality in Europe Characteristics, effectiveness and implementation of different strategies Edited by: Reinhard Busse Niek Klazinga Dimitra Panteli Wilm Quentin Keywords: QUALITY ASSURANCE, HEALTH CARE - methods DELIVERY OF HEALTH CARE - standards OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE) COST-BENEFIT ANALYSIS HEALTH POLICY © World Health Organization (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) and OECD (2019) All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/ pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Indeed, this document, as well as any data and map included herein, is without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies or OECD in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of the OECD or of its member countries or the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. ISBN 978 92 890 5175 0 OECD ISBN 978 92 648 0590 3 Printed in the United Kingdom Table of contents Foreword from the OECD xi Foreword from the European Observatory on Health Systems and Policies xiii List of tables, figures and boxes xvi List of abbreviations xx Author affiliations xxiii Acknowledgements xxvi Part I Chapter 1: An introduction to healthcare quality: defining and explaining its role in health systems 3 Reinhard Busse, Dimitra Panteli, Wilm Quentin 1.1 The relevance of quality in health policy 3 1.2 Definitions of healthcare quality 5 1.3 Dimensions of healthcare quality 7 1.4 The role of quality in health systems and health system performance assessment 9 1.5 What are quality improvement strategies? Aims and structure of this book 14 References 16 Chapter 2: Understanding healthcare quality strategies: a five-lens framework 19 Dimitra Panteli, Wilm Quentin, Reinhard Busse 2.1 Introduction 19 2.2 The first and second lens: three dimensions of quality and four functions of healthcare 20 2.3 The third lens: three major activities of quality strategies 21 2.4 The fourth lens: Donabedian’s distinction between structure, process and outcome 24 2.5 The fifth and final lens: five targets of quality strategies 25 2.6 Putting it together: the five-lens framework of healthcare quality strategies 26 2.7 Quality strategies discussed in this book 27 vi Improving healthcare quality in Europe 2.8 Concluding remarks 29 References 29 Chapter 3: Measuring healthcare quality 31 Wilm Quentin, Veli-Matti Partanen, Ian Brownwood, Niek Klazinga 3.1 Introduction 31 3.2 How can quality be measured? From a concept of quality to quality indicators 32 3.3 Different purposes of quality measurement and users of quality information 32 3.4 Types of quality indicators 37 3.5 Advantages and disadvantages of different types of indicators 39 3.6 Aggregating information in composite indicators 40 3.7 Selection of indicators 44 3.8 Quality of quality indicators 46 3.9 Data sources for measuring quality 48 3.10 Attribution and risk-adjustment 53 3.11 Conclusion 56 References 59 Chapter 4: International and EU governance and guidance for national healthcare quality strategies 63 Willy Palm, Miek Peeters, Pascal Garel, Agnieszka Daval, Charles Shaw 4.1 Introduction 63 4.2 The international dimension to quality in healthcare 64 4.3 The EU’s approach to quality 73 4.4 Conclusions 91 References 96 Part II Chapter 5: Regulating the input: health professions 103 Anika Kreutzberg, Christoph Reichebner, Claudia Bettina Maier, Frederic Destrebecq, Dimitra Panteli Summary 103 5.1 Introduction: health professional regulation and its contribution