1. 1 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Incentives to implement the QuaTheDA Reference System a quality norm for drug treatment services René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Translating Standards into Practice June 16th, 2011

2. 2 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Presentation 1.The quality approach according to QuaTheDA 2.Setting of the project and general strategy 3.Five examples of incentives - Training activities - Quality instruments - Participative process - Certification - Promotion of QuaTheDA 4.Conclusion

3. 3 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA The Reference System QuaTheDA (Quality Therapy Drug Alcohol) is a quality norm recognised by the Swiss Accreditation Service is used for a certification process by external audits was specifically developed for institutions in this field, on the general model of the ISO-Norm is based on evidence based quality standards was elaborated in collaboration with professionals is targeted at structure and process quality of institutions

4. 4 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA Definition: list of all structure and process related quality requirements which have to be fulfilled to become QuaTheDA certified Can also be used as a self evaluation tool

5. 5 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA Requirements are divided into two parts: 1.Requirements concerning management and support processes of any kind of addiction treatment services 2.Requirements concerning the treatment processes for 8 specific types of services: - in-patient therapy - out-patient therapy - out-patient therapy with substitution programmes - harm reduction services - etc

6. 6 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA addressed topics for requirements of management: Management processes Support processes Supplies processes for 8 specific types of services 1.Management and therapy concepts 2.Directorate and organisation 3.External communication and cooperation 4.Quality management and controlling 5.Mission statement and strategy development 1.Manpower / staff 2.Finances 3.Hygiene, housekeeping, waste management and security 4.Patient security 5.Legal prescriptions and guide lines

7. 7 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA addressed topics for requirements of treatment processes: Management processes Support processes Supplies processes for 8 specific types of services 1.Assessment and admission 2.Therapy and rehabilitation 3.Leaving and closure 4.Networking 5.Reporting

8. 8 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 The quality approach according to QuaTheDA 2 examples of requirements: B/5: External communication and cooperation - Partners with strategic signification - Form of communication with them - Written cooperation convention - etc. B/8: Manpower - Special qualification of the staff - Ongoing education - Regular support activities for the staff - Health and security measures for the staff - etc.

9. 9 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Setting of the project and general strategy In Switzerland, most of the competences on health issues lie with cantons The drug policy in the 90s put the Federal Office of Public Health (FOPH) in a leading position. It gave us the legitimacy to become active in this new field Another Federal Office created the opportunity to act: it decided in 1998 that in-patient therapeutical institutions had to fulfil quality standards in order to get their fundings Facing a completely new situation, institutions were prepared to accept support

10. 10 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Setting of the project and general strategy Window of opportunity to set up a quality project based on following considerations: If each institution would choose its own quality model, dialogue and comparability between institutions would become very difficult Even more important than the quality model was starting a process of continuous improvement

11. 11 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Setting of the project and general strategy Strategical consequence: To establish a quality norm and quality management system valid for the whole addiction field, so that professionals apply a similar model and think in the same logic As having no legal authority to impose as such, necessity to find incentives to convince the institutions and the Cantons to adopt this quality model

12. 12 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Setting of the project and general strategy Objective of FOPH: To involve the whole addiction field in a quality improvement process starting with the in-patient treatment institutions that are under external pressure to act. Once this professional sector is covered, go forward with out- patient treatment services (therapy and harm reduction)

13. 13 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 1st incentive: training activities 2000: FOPH organized a free training program for all the in- patient treatment institutions which would implement QuaTheDA FOPH published a manual as implementing support Advantage for the institutions: - they are being assisted in facing a big challenge: a new activity based on an approach, which is not familiar to their way of thinking - they do not have to pay for a quality consultant - they get in contact with other institutions and can exchange best practice

14. 14 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 1st incentive: training activities 2006: Organizing for out-patient treatment institutions a new training program for the implementation of the new QuaTheDA Modular Reference System Publication of a new manual giving explanations to the requirements Organizing yearly continuing education activities to current issues as e.g. how to elaborate a new strategy for the institutions, how to plan and conduct an internal audit, etc. These training activities are not free anymore Organizing every two years a national symposium dedicated to current issues

15. 15 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 2nd incentive: quality instruments Four different questionnaires for measuring the satisfaction of patients: - QuaTheSI I 40 for in-patient institutions - QuaTheSI II 17 for out-patient institutions - QuaTheSI III 18 for out-patient institutions with substitution - QuaTheSI VII 19 for institution providing harm reduction facilities An evaluation is done once a year on national level by an external institute Each institution gets its own data and can compare them with others. By analysing its results it can elaborate measures to improve the quality of their facilities To motivate the institutions to participate, the first 3 years are free One questionnaire for measuring the satisfaction of staff Next step is to make available instruments to measure outcomes

16. 16 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 3rd incentive: a participative process The 2 Reference Systems were elaborated with the main stakeholders: the professionals and the Cantons The QuaTheDA Modular Reference System is currently being reviewed together with stakeholders Through that participative process, the FOPH wanted to create the feeling - that QuaTheDA is adapted to their needs. It is made for them. - that it reflects a general standard of quality accepted by all stakeholders - of belonging to the community (of the « outstanding and recognized institutions ») of the addiction field

17. 17 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 4th incentives: a certification system To be QuaTheDA-certified, the institutions have to pass an external audit with officially accredited certification centers Advantages of a certification : - institutions get a recognition of their general quality level which is recognised by the sponsors - the certification has the same value as an ISO-certification - through the external audit, the institutions receive the external view of a neutral person able to point out weaknesses of the institution - the date of the external audit gives a concrete goal to reach for the project of implementing a QMS. You avoid the risk of a never ending project.

18. 18 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 5th incentive: promotion of QuaTheDA at the sponsors Regular information of cantons and cities about the different aspects of the project To give them the opportunity to review the requirements of the QuaTheDA Reference System and make their proposals To convince cantons and cities to include in service agreements with the institutions the obligation of being certified according to QuaTheDA

19. 19 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Incentives: results 57 in-patient treatment institutions are certified according to QuaTheDA (about ¾ of this type of institutions) and more than 100 out-patient treatment services (including services providing harm reduction facilities) 2/3 of the Cantons recommend QuaTheDA

20. 20 Département fédéral de l'intérieur DFI Office fédéral de la santé publique OFSP Division Programmes nationaux de prévention Incentives to implement the QuaTheDA Reference System René Stamm, Federal Office of Public Health, Switzerland EQUS Conference Brussel, June 16th 2011 Conclusion The FOPH followed a double incentive strategy that could be called « The carrot and the stick ». The 3 first ones are « carrots» and the 2 last ones are « sticks » Based on the belief that both of them are equally important Using only « carrot like » incentives is idealistic Using only « stick like » incentives creates resistance The long-term vision of the QuaTheDA project is to enable all stakeholders to move upwards in an improvement process of the quality of their facilities This has to be made step by step. The next one is dedicated to outcome quality.