Danish Institute for Quality and Accreditation in Healthcare; februar 2016 The Danish Healthcare Quality Programme

2 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Prehistory

3 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Intentions of DDKM Nationwide model Evaluating and supporting quality improvements Including publically financed health services Danish standards – on an international level Promoting good patient journeys

4 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Preconditions A quality culture should be promoted in the entire healthcare sector ”You can make staff work in a certain way with specific tasks for a while, but fostering a quality culture is different from and more than executing individual tasks” In other words: a concern for leaders on all levels

5 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; What have we accomplished (Feb 2016)? Published accreditation standards for Hospitals (1. and 2. version) Community pharmacies (1. and 2. version) Community based healthcare (1. and 2. version) The prehospital sector (1. and 2. version) General practitioners (1. version) Specialist physician practice (1. version) In pipeline: Chiropodists, physiotherapist, chiropractors Supported clients by courses, counselling and ressource materials Developed a survey model and trained more than 100 surveyors Conducted approximately 700 surveys Standards in English available at

6 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Where are we now (Feb 2016)? The Danish Government and the Danish Regions have decided to discontinue accreditation of public hospital and the prehospital sector after the completion of two cycles in favour of a strategy emphasizing the creation of a locally founded quality improvement culture Accreditation programmes for out-of-hospital practioners (GP’s etc.) will be launched (some are already) Accreditation of community pharmacies, private hospitals, and community based healthcare will continue to be offered More information at

7 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; The structure of an accreditation standard in DDKM The standard heading expresses and the fields ”purpose” and ”content” of the standard explain, what we aim to achieve The elements describe, how we will evaluate the client’s effort to achieve this aim

8 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; DDKM is not based on the assumption that every- thing should be fixed by documented procedures Everyone should share a common view on, how given tasks should be performed – including on, when there is one single way to do it Documentation serves two purposes: To ensure that we agree on, what we have agreed on To help us remember, when we need to Documentation of procedures should be ”just enough”

9 23. februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Data is collected for different purposes Signals to make sure that we are on the right track (when caring for a single patient, or as an organization) Investigation and follow up, when improvement is desired and implemented

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Outcome or process measurement? Outcome measures, when we wish to assert that we have achieved, what we aimed for Process measures tightly coupled to an outcome may also be used for this purpose Process measures, when we wish to understand, why our outcomes are as they are

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Don’t mistake the means for the end The quality criterion is not ”correct procedure”, but ”desired outcome” And look at the performance of the whole system from the perspective of the service user

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Two related but different purposes of an accreditation survey To evaluate, if the client meets the miminal requirements inherent in the accreditation standards – and consequently can be awarded accreditation To give the client feedback on the efforts to achieve the aim of the accreditation standards – in a way that stimulates and inspires to further quality improvement – identify opportunities for improvement This may be relevant even in situations, where no follow up is needed, before accreditation can be awarded

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; The minimal requirement can be stated explicitly in the standard – or it can set by a regulatory or professional norm Examples: Regulatory norms for the medication process, identification of patients, or infection hygiene Professional standards for sedation without the involvement of anaesthesiological staff

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Some standards do not set an identifiable minimum level, but point out a direction For example standards on involving service users and their families in care decisions

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Many elements of DDKM are explorative questions ”When interviewed, managers and staff can account for XXX” Surveyors should Take an explorative (”curious”) approach Show respect for other people’s solutions But there is a need to avoid that any answer is considered right

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; The importance of the accreditation standard to the service user can be direct or indirect Examples: Direct: Cardiac arrest, use of clinical guidelines Indirect: Quality improvement, risk management, staff competencies

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; The elements should not be interpreted as rigid prescriptions We subscribe to the excellent way this was expressed by the Royal Australian College of General Practitioners: “The RACGP envisages that formal accreditation against the RACGP Standards will be based on common sense and will not seek to penalise or exclude practices on the basis of technicalities.” (From the introduction to the RACGP standards for general practice)

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; Triangulation is the cornerstone of survey methodology What can the person responsible for the task tell or demonstrate? Is the surveyor able to find ”traces” from situations, where this task was performed? Patient records Other documents Direct observation Interviews with patients or patient relatives What is done to support that the task is performed as intended? Guidelines and written instructions Checklists Support built into the workflow (for example IT interfaces)

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; What meaning should patients or the public attribute to accreditation? ”A clinic that works in a sensible way; one that we can trust” IKAS does not ascertain that everything in the records is OK DDKM should not be understood as a system that implies that ”someone” should document and check compliance with fixed procedures at all times IKAS cannot guarantee that everything will be OK in the future

februar 2016 Danish Institute for Quality and Accreditation in Healthcare; More information and resources can be found at