Payers: Maarten Akkerman – Netherlands Jos Djikers – Netherlands Ioana Bianchi – Romania Stig Harthug – Norway Michael Surkitt-Parr – UK Francesco Venneri (& Ilaria Benali) – Italy Patient representatives: Malcolm Alexander – UK Jolanta Bilinska – Poland Birgitte Holmark – Denmark Huib Hoogendijk – Netherlands Graham Tanner – UK Garance Upham (& Jean-Jacques Monot) – France Peter Walsh – UK Hospital representatives: Jesus Canora-Lebrato – Spain Dorthe Gylling Cruger – Denmark Jeanette Hounsgard – Denmark Kinga Jako – Hungary Leon Luyten – Belgium Tarmo Martikainen – Finland Teele Orgse – EstoniaLaimutis Paskevicius – Lithuania Patricia Snell – UK Els van der Wilden – Netherlands QUASER team members Naomi Fulop, Glenn Robert Janet Anderson Susie Edwards Susan Burnett Kathryn Charles Roland Bal Karina Aase Johan Calltorp Johan Sanne Annette Karltun
2 Summary of workshop
2.1 Welcome and introduction to QUASER
2.2 Questions invited from participants
2.3 Overview of QUASER Hospital Guide and Payer Framework
The participants broke into three groups for a facilitated focus group discussion of the Guides. The three groups were – hospital, payer and patients. Detailed notes of the discussion in each focus group are contained in the appendices.
Feedback from each of the three groups was provided to the larger group
2.6 Participant comments
Further comments were then invited from participants
1. On the issue of implementation – use implementation research. Involve the staff and patient groups in looking at how it can be implemented and improved in future
The hospital group discussed the need to document what was found and how to take it forward
The simple act of staff seeing whether they have improved things will encourage improvements. As well as implementation research, consider systems thinking
Recent research he had been involved in had the outputs put up on the ward so that staff and patients could see them. This helped get the message through
Need to get the patient perspective into the guides as a whole. Transparency is very important for hospitals, and you need to know how transparent the hospital is when you are doing the self-diagnosis – patients can be an important voice here
NF asked someone from the payers group to explain what they had been discussing about how they would use the payer guide in dialogue with the hospital It shouldn’t become a tool – important to keep in mind the end aim. They (insurance company in the Netherlands) are delegated by patients to buy good healthcare for patients, ie the focus is what the outcome is. Could use the framework to form a discussion with the patients to see if they agree with the patients about what good quality is. It is always helpful to have a longer term relationship with hospitals, this can help improve quality. A condition of giving a contract to a hospital could be to ask them for their quality data in return. Hospitals define quality at present – need to have the patient’s voice in there. In future contracts, patient safety is number 1 priority – there are too many mistakes in Netherlands hospitals. They have a contract with a patient group in the Netherlands to give them questions to ask the hospitals.
Another situation in the Netherlands is that some hospitals still don’t have a contract for this current year. Some insurance companies only focus on the money not on quality. The guides could help both payers and hospitals. They are currently being asked in the Netherlands to concentrate healthcare, but you can’t ask patients to travel 200km for treatment. There needs to be a way to help the dialogue between hospitals and payers, and the guide could be useful in this respect.
6. Raised the different situations found in different countries eg some countries have block funding eg by councils
Even so, the pressures are the same. Payers only talk to them about cost, not quality
Focus on cost is not a good way forward
Same issues need to be discussed with hospitals and payers, so maybe there doesn’t need to be two guides? In tax funded countries you don’t need to worry about the funding, and can base the targets/focus on quality measurements, so it could work to have the same guide for both parties
In many countries you end up paying more for bad quality because you pay for both the initial treatment and then the complications that arise also
Carers should also be involved more, and could use political risk to lead service changes eg invite politicians to back the guides as this will ensure that it happens. Just one patient having a bad outcome affects a lot of people as a result and so this can generate political pressure from a lot of people
Accountability is not present, have discussed accountability of payers and for patients This runs through several of the challenges. In Finland for example there is a democracy arrangement and so you get accountability. The UK is moving towards it now with CCGs.
There is different accountability in different countries, so need to allow for these different contexts eg some medics feel more accountability towards professional bodies than to hospitals.
2.7 Next steps
1. It would be useful to have the guides on site to try out
2. Good to test it and also to get together again
3. Test it first and then meet again to discuss
4. Agreed this would be most useful way
5. Make sure use organisations involved to help with dissemination
6. Possibility of having either a smaller group in person, or a larger group of people via an online means. Also raised the fact that it is hard to engage payers, and also that they could involve more countries if online
7. Suggested inviting more CCGs
8People from the CCGs were the people who had dropped out this week, although had discussions with MSP (Payer) about involving them more
9. They are key as they will be holding hospitals accountable. She will send some contacts.
10. The UK system is in flux. Other people of influence include the WHO and DG Sanco at the EU. Need dissemination throughout all EU
11. Asked if anyone from QUASER would attend the ISQua conference in Geneva
12. Confirmed attendance there and at others too eg EUPHA, EHMA
13. Suggested sharing email addresses within the group
The participants were thanked again and the workshop closed with a group photo.