QUALITY REPORT 2016/17 EXPERTISE YOU CAN TRUST. HIRSLANDEN A MEDICLINIC INTERNATIONAL COMPANY 2 FINANCIAL YEAR AT A GLANCE The Hirslanden Private Hospital Group in figures, as of 1 July 2017 17 2,000 9,920 hospitals in 11 cantons affiliated doctors staff with employed doctors As of 31 March 2017 100,293 466,025 5,952 inpatients care days * newborns * based on midnight census, without newborns CONTENTS QUALITY PERFORMANCE Quality at Hirslanden 4 Financial year 2016/17 in figures 30 Patient satisfaction 6 Range of services 31 Patient safety 10 SwissDRG 32 Quality medicine initiative 24 Diagnoses and operations 34 Peer review procedure 25 Diagnosis related groups (DRG) in figures 36 Comprehensive quality management system 28 REFERENCES Infrastructure of the hospitals 38 Glossary 40 Swiss sites 42 FINANCIAL YEAR 3 CONSOLIDATED FIGURES The most important consolidated figures for 2016/17 Change compared to 2014/15 2015/16 2016/17 2015/16 Patients Patients, maternity patients 1 94,037 98,609 100,293 2% Patient days 2 453,741 469,167 466,025 -1% Length of stay 4.8 4.8 4.6 -2% Turnover Turnover total (in CHF, millions) 1,563 1,647 1,704 3% Turnover inpatient services (in CHF, millions) 1,222 1,288 1,318 2% Turnover outpatient services (in CHF, millions) 262 275 300 9% Other operating income (in CHF, millions) 79 85 86 1% Number of employees Average FTEs 3 6,213 6,573 6,722 2% 1 Inpatient admissions, without newborns 2 Based on midnight census, without newborns 3 Apprentices, students and interns uniformly weighted, incl. employed doctors About Hirslanden The Hirslanden Private Hospital Group consists of 17 hospitals – many of which have an outpatient surgical centre and an A&E department – and runs 4 outpatient practice centres, 15 radiology centres and 4 radiotherapy centres. This makes it the largest medical network in Switzerland. With over 9,900 staff and around 2,000 affiliated doctors, the Hirslanden Group offers a comprehen­­sive range of services across all levels of treatment, from basic care through to diagnostics and highly specialised university-level medicine. The Hirslanden Group and its hospitals are on the hospital list of all 11 of their respective cantons, thus playing an important role in the provision of healthcare to the people of Switzerland. The proportion of patients with basic insurance is constantly growing across the Group, and has now reached 45 percent. The quality of medical care, patient satisfaction and the resulting patient benefit are of the utmost importance at Hirslanden. This is why the Hirslanden Private Hospital Group has a highly developed quality management system and has published a quality report every year since 2010. 4 QUALITY QUALITY AT HIRSLANDEN THE HIRSLANDEN PRIVATE HOSPITAL GROUP HAS ACQUIRED LARGE AMOUNTS OF QUALITY DATA FOR OVER TEN YEARS AND PUB- LISHED THIS IN ITS QUALITY REPORT SINCE 2010. THE ACQUISITION AND PUBLICATION OF THIS DATA HELPS TO IMPROVE THE QUALITY OF TREATMENT IN SWISS HOSPITALS AND PROMOTE COMPETITION BETWEEN THEM. The primary goal of the Hirslanden Private Hospital Group is bodies in the field of quality management. These bodies to generate patient benefits. In order to achieve this goal are also responsible for deriving the relevant measures and consistently increase patient benefits, treatment quality from the results and thus ensuring a continuous process and patient safety have to be guaranteed. Each year, as of improvement. part of comprehensive quality measurements, Hirslanden analyses whether this takes place and to what extent. Hirslanden has several bodies involved in assessing and maintaining quality. These include the cross departmental quality commission, a hygiene committee and a commit- MEASURING QUALITY tee on critical incidents (Critical Incident Reporting System, Measuring the quality of medical care is an extensive CIRS) at every hospital, plus the position of Head of Me- and complex task that requires a great deal of commitment dical Systems, which has been in place at every Hirslanden from all hospitals. When measuring quality, Hirslanden hospital since 2014. The Head of Medical Systems sup- bases its results on clinical performance indicators that ports the hospital manager in matters relating to the qua- have been developed and improved over many years, lity of medical care and patient safety, and is tasked with together with national and international healthcare guide- supervising the provision of medical services. He is also lines. By using the same surveys at each hospital, those responsible for ensuring the regulatory requirements with a similar range of services can be compared with one and cantonal performance mandates are implemented another and specific benchmarks can be derived from correctly. the results. These benchmarks help when assessing performance COMPARING RESULTS and defining measures for further improvements – both in As previously mentioned, one advantage of making con- terms of treatment quality and patient safety. Further- tinuous group wide quality measurements is that com- more, the acquisition of national and international perfor- parisons can be made between hospitals and benchmarks mance indicators also allows comparisons to be made derived accordingly. These are always based on the with hospitals at home and abroad. principles of best practice. However, not only the results are compared. The quality management teams at the hospitals are also in constant contact with each other in UNDERSTANDING THE QUALITY order to draw up concrete measures and proactively MEASUREMENTS prevent losses in quality. In order to understand the methods and basic principles involved in the different quality surveys, an in- depth look at the material involved is required. However, it is not only the survey itself that has to be looked at from a range of different viewpoints – the complexity of the results them- selves also demands comprehensive analysis and inter- pretation. The results of the quality measurements are ana- lysed and assessed at Hirslanden by different specialist QUALITY 5 QUALITY OF MEDICAL CARE IN QUALITY OF MEDICAL CARE AT HIRSLANDEN SWITZERLAND IN THE 2016/17 FINANCIAL YEAR There are many initiatives for improving the quality of medi- Various quality indicators collected annually by Hirslanden cal care in Switzerland, which shows how committed the are presented and discussed below. A brief summary of the country is to ensuring a high-quality, constantly improving key results should enable an overview to be gained in ad- healthcare system. As a member of various bodies in the vance of the most important changes: field of quality improvement, Hirslanden is also making an • 92.5% of the patients surveyed rate the quality of their active contribution here. Among others, the Hirslanden treatment as either very good or excellent in the ANQ Private Hospital Group is a member of the National Associ- survey. ation for Quality Development in Clinics and Hospitals • The figures for the indicators “unplanned readmissions”, (ANQ). The association is funded by the H+ hospital asso- “unplanned reoperations” and “documented falls” have ciation, the cantons, the Association of Health Insurers risen slightly – though not significantly – compared to the (santésuisse), and the Swiss social insurance agencies. Its previous year. goal is to find ways of uniformly measuring quality results • In the area of infection monitoring, the positive trend in Swiss hospitals and then using these results to establish towards lower infection rates as seen in recent years has approaches for improving quality. continued. • The effective mortality rate of patients admitted to the The ANQ measurement plan includes the following indica- intensive care unit has remained stable compared to the tors for acute somatic medicine: previous year. • Rehospitalisation rate (SQLape) • Reoperation rate (SQLape) • Postoperative wound infections (with Swissnoso) • Patient satisfaction • Prevalence of decubitus (LPZ) • Prevalence of falls (LPZ) • Implant register SIRIS Hirslanden sees the ANQ measurement plan as a helpful instrument for comparing the quality of Swiss hospitals, and complements it by acquiring additional indicators. On the following pages, you will find detailed information on patient satisfaction, unplanned readmissions, unplanned reoperations and falls. Moreover, Hirslanden also publishes data on infection monitoring and patient safety, plus data on mortality in intensive care units and according to CH-IQI (Swiss Inpatient Quality Indicators; quality indicators for Swiss acute care hospitals from the Swiss Federal Office of Public Health). 6 QUALITY PATIENT SATISFACTION PATIENT SURVEYS ARE AN INTEGRAL PART OF QUALITY MANAGEMENT AT THE HIRSLANDEN PRIVATE HOSPITAL GROUP. THIS IS THE ONLY WAY TO ENSURE THAT THE HOSPITALS CONTINUALLY IMPROVE IN MEETING THE NEEDS OF PATIENTS AND THUS INCREASE PATIENT BENEFITS. Each year, the patient surveys illustrate the potential for Another advantage of integrating the HCAHPS questions is further improvements and developments in patient treat- that they also highlight the interactions between patients ment and are thus an important element in increasing and nursing staff – a key aspect of patient welfare. patient benefits. Surveys of patient satisfaction vary accord- ing to their scope and depth. While some surveys provide Since spring 2017, the Hirslanden Private Hospital Group a global – and thus less detailed – analysis of patient satis- has surveyed patient satisfaction according to the methods faction, other surveys