Approach to quality management at the

University Hospitals Leuven (UZ Leuven), Belgium

Johan C. Kips, MD, PhD,

CEO
 Hospital quality management

• Characteristics of high quality care :

- safe
- effective
- patient-oriented
- timely
- efficient
- equitable

Crossing the quality chasm, Institute of Medicine 2001

Hospital quality management

Result
(quality improvement)
Value creation =
Cost
Quality management at UZ Leuven

• UZL in Belgian health care

• Quality management at UZ Leuven :

- strategic options
- management tools
- benchmarking
 Belgium

Flemish Region : 6 mio inhabitants

12.211 km2
Dutch speaking

Brussels Leuven

Belgium : 10.5 mio inhabitants

30.528 km2 (~ Maryland)
Federated union of Flemish, Brussels
and Walloon Region
Gasthuisberg - Health Sciences Campus
Profile of acute hospitals in Belgium

Hospitals number beds admissions

79 23.420 1.128.456
Small (< 500 b)
(74 %) (54 %) (55 %)
20 13.583 647.192
Large (> 500 b)
(19 %) (31.3 %) (31.5 %)
7 6.379 278.124
AMC
(7 %) (14.7 %) (13.5 %)

Belgium 106 43.382 2.053.772

Positioning UZ Leuven

Hospital Number of beds

UZ Leuven 1955

Karolinska Stockholm, Sweden 1700

Oxford Radcliffe Hospital Trust, UK 1400

LUMC Leiden, the Netherlands 800

Average hospital Flanders 445

Key figures UZ Leuven 2009

Out patients 2.760 / d

Day care 352 / d

Admissions 247 / d

ER visits 211 / d

Surgical procedures 203 / d

Organisation of health care in Belgium

• Broad accessibility to care : abundant offer

• No gatekeeping / echelons : freedom of choice for the patient
• Fee-for-service payment, based on extensive tariff list
=> high patient satisfaction
no waiting lists
percieved good quality (no formal quality control)

• Extensive coverage through compulsory health insurance

system
=> low unit cost, high throughput volume
high degree of equity
Organisation of hospital care in Belgium

• Dual organisation :
- not-for-profit institutions (majority private)
- self employed physicians
participation in hospital management within legal
framework

• Dual financing :
- hospital activities : pathology linked
(APR-DRG based case-mix) within closed budget (40 %)
- medical activities : fee-for-service (40 %)
co-financing of hospital activities within legal framework
Legislation on health care in Belgium

• Federal competence : curative care

social security based compulsory health insurance system

legal framework on health care providers and provisions

including hospitals
defines minimally required (mainly structural) quality
standards for hospitals
Legislation on health care in Belgium

• Regional competences :
preventive care
responsibility with regard to hospitals :
- co-funding hospital infrastructure
- audit of federal quality standards
can (and does) add additional requirements : presence of
CQI program based on self evaluation

• As yet, no formal accreditation process required

• No legal obligation on public reporting of outcome data
Quality management at UZ Leuven

• UZL in Belgian health care

• Quality management at UZ Leuven :

- strategic options
- management tools
- benchmarking
Mission UZ Leuven
Leading European Academic Health Services System

Strategy UZ Leuven 2009 - 2014

• Added value creation
innovative care / quality improvement
• Integrated approach hospital / university
translational research
• Networking
planning with gp’s, regional hospitals, elderly care units
• Recruitment and retention of human capital
top employer award
• Organisational efficiency
Department specific ISO and other accreditations

• JACIE-accreditation : hematology department

• BFHI - Baby friendly hospital (UNICEF – WHO)
• ISO-Certificate:
– Medical laboratory, center for molecular diagnostics
– Laboratory for clinical genetics
– Fertility center
– Nuclear medicine
– Pharmacy
– Center for forensic medicine
• FAVV – Smiley (Federal Agency for safety of foodchain)
• AnySurfer quality label for external website www.uzleuven.be
Added value creation as strategic option

• Continuous improvement of quality and expertise available

within UZL :

Compliance with international standards on hospital wide

quality and patient safety
=> accreditation by the Joint Commission International (JCI)

Definition of disease specific standards of quality of care

=> designing care programs within UZL
 Care programme centered organisation structure
Medical management
Exec
Com

CP committee : 8 clinical dept. heads

Clin dept. Clin dept. Clin dept.

Operational
management
Quality of :
-patient/staff orientation
-financial performance Aim of care programs is to optimise :
- quality of patient care
- patient safety
UZL care programs

AC’
s

Diagnostische Module 1

Diagnostic module

Quality
Therapeutic module 1
outcome
Homogenous
patient Therapeutic module …
group

Rehab module 1

Rehabilitation module …

Follow up Module 1

Follow up module …
 Care programs : linking outcome to cost

10,0

9,0
Income
8,0

7,0

6,0 implant defib

162
5,0
161 cardiac valve surgery
4,0

3,0 163165 160

172
2,0 166
168169
CABG
1,0 167
174
170
173 180
177
0,0 175 178 171

-1,0 176
179
-2,0 PCI
-3,0

-4,0
Input
-5,0
-5,0 -4,0 -3,0 -2,0 -1,0 0,0 1,0 2,0 3,0 4,0 5,0

Cardiovascular care programs

Care programs : linking outcome to cost

Labeling in HIS
- Identifying/following patient track throughout care process
- Administrative optimalisation (eg diagnostic work up,…)
- Link with clinical paths (eg nursing plan,…)

Process optimalisation
- Shortened length of stay
- Reduced waiting times
- Rational medication use

Pathology oriented communication system

- Internally : defined uniform care process (teaching aspect)
- Externally : guide for referral to dedicated staff member
Quality management at UZ Leuven

• UZL in Belgian health care

• Quality management at UZ Leuven :

- strategic options
- management tools
- benchmarking
EFQM model for integrated quality management

People Staff
mgt appreciation

Patient Key results

Strategy (Care) and
Leadership appreciation
process transparency
mgt

Resources Society
mgt appreciation

Organisation Results

Improvement and
innovation
Quality management outcome measures
People :
Absenteïsm Key results
Accidents
Mutations/efflux Nosocomial
infectiions
(MRSA, C. diff,…)
Patiënts :
Waiting times
Transfusion reactions
P-iMS
CPOE drug/drug interactions
Decubitus

HSMR
Society :
Q in yearly report
Certifications
Accreditation

Results

Improvement and innovation

Quality Management : overall aim
public accountability

aim :
delivery
of high
quality care
“CQI” process
improvement measurements
- internal follow up
PDCA cycle - external benchmarking
Quality balanced scorecard

• Combines non-clinical and clinical process / outcome

indicators
- collected centrally (eg overall in hospital mortality) or at
department level (eg CABG mortality)
- in hospital follow up and external benchmark when available
(databases provided by federal administration or commercial
initiatives)

• To be complemented by data from the Flemish Hospital

network K.U.Leuven
 Flemish Hospital network K.U.Leuven

Mariaziekenhuis
Sint-Blasius AZ Turnhout Overpelt
Sint-Lucas Dendermonde
Brugge Sint-Franciskus
Heusden Zolder
Damiaan
Oostende Maas en Kempen
Maaseik
Groeninge ZOL
Kortrijk Genk

Zusters van Barmhartigheid Jessa Ziekenhuis

Ronse
Sint-Trudo
Sint-Truiden
O.L.Vrouwziekenhuis Imelda
Aalst Bonheiden
Sint-Elisabeth
Herentals
AZ Sint-Maarten UZ Leuven
AZ Diest
Mechelen
Flemish Hospital network K.U.Leuven
CQI programme

• Scope of indicators :
- Clinical (medical and nursing) performance and patient safety
- Patient orientation
- Human resource management
- Financial performance

• Aim :
- Benchmarking to support internal quality improvement initiatives
- Identification of best practices to improve efficiency
Approach to quality management
Conclusions

• Aim is to provide added value

outcome as primary objective

• Importance of CQI culture within hospital

- involving all departments
- appealing to willingness to provide « care »

• Need for / use of valid data

- benchmarking with trusted partners