Quality

In fulfilling its triple mission of care, teaching and research, HUG is guided by four values, among which quality illustrates a particularly rigorous internal policy, focused on care safety and efficiency.

This demand for high level of quality in all aspects of its work is particularly embodied in the first goal of the HUG 2010-2015 strategic plan, which is associated with an action plan with eight specific projects.

A space for mediation, listening and speaking provides patients and their families with the opportunity to express the difficulties encountered during their visit to the hospital. It is also planned to involve patients in improving quality care. See the 2015 activity report of the mediation space (FR).

Guarantor of this commitment, the Care Quality Division's mission is to promote quality care at HUG and to best meet the needs of the general public. It helps to improve quality in the following areas:

Quality management model

The model of the European Foundation for Quality Management (EFQM) has been taken as a reference by HUG for its institutional quality approach. It is based on good management practices and promotes self-evaluation through the following nine criteria: leadership; policy and strategy; staff, partnerships and resources; processes; results for clients; results for staff; results for the community; key performance results.

Care process

The clinical route corresponds to the detailed description of the stages in patient care for a disease, intervention or a specific dependency situation. The duration of each stage, the objectives, the players involved and the actions to perform (treatment, care, information, etc.) are described.
The clinical route has the overall objective to improve care quality and efficiency by decreasing the variability of practices for patients with the same diagnosis. It builds on the recommendations of good clinical practices and takes the local context into account.
Generally clinical routes are used for conditions that have a high volume of patients, with a variability in care and involving a multidisciplinary team. This methodology facilitates care coordination and integration.

Three clinical itineraries were established in 2011: heart failure, breast cancer, total hip replacement.
Five new itineraries are being developed for 2013: back pain, peripheral arterial disease, lung cancer, primary malignant liver tumors, dementia.

In addition, six dimensions have been identified for a more accomplished control over quality of care:

  • Care Safety: measuring and reducing risks associated with care, for example the risk of infection and hospital-acquired infections
  • Efficiency: efficient use of resources, skills and equipment
  • Effectiveness: in particular with the introduction of clinical itineraries defining the detailed steps in patient care for a specific disease or intervention.
  • Fairness: guaranteeing all patients without distinction in care quality
  • Patient partner concept: providing care that respects the person, their preferences, needs and values.
  • Timeliness: reducing wait times for patients

 

Patient Satisfaction Surveys

The patient satisfaction rate is a recognized indicator of service quality.

HUG began to carry out satisfaction surveys on an institutional level in 2001. Since 2010, they have been carried out annually.

Satisfaction surveys are conducted with all adult patients residing in Switzerland, hospitalized for more than 24 hours during a specified period, after their discharge from HUG. Patients are contacted approximately 4 weeks after leaving. About 2,500 patients are included. The response rate is between 65% and 70%.

The questionnaire used is the questionnaire developed by the Picker Institute. It has 44 questions grouped into 9 satisfaction dimensions:

  •   Moral Support
  •   Respect of the Individual
  •   Information for Family and Loved Ones
  •   Information for the Patient 
  •   Surgery Specific Information
  •   Physical Well-Being 
  •   Discharge
  •   Treatment Coordination
  •   General Impression

Questions are added occasionally to meet the concerns of HUG on subjects concerning, for example, the assessment and treatment of pain, feeling safe, hospitality aspects, and the organization of the discharge.

Results are shown as problematic values. Problematic values include answers such as "sometimes yes" or "no" on an answer scale including "Yes, always" "Yes, sometimes" "No". They are presented by the Care Division (or group of divisions) by comparing the values to previous surveys. The objective of the presentation by the Care Division is to facilitate the use of results by divisions and encourage the carrying out of improvement projects.

Results indicate that the aspects of care that patients are least satisfied with involve discharge planning, coordinating care, information received, the opportunity to confide when there are concerns.
Patient dissatisfaction in terms of these different areas is also a concern for HUG. Thus, actions that HUG is currently taking in the areas of patient information, clinical pathways, safety (training in incident analysis, establishing incident groups), and discharge planning must help improve patient satisfaction over the next few years.

Incident Management

HUG has established an incident management system,  that  staff is specifically trained in.

This management is organized in divisions, where incident groups are formed by staff groups and middle management.Reporting an incident is voluntary. Reporter confidentiality is guaranteed, as well as the disciplinary immunity of the persons involved in the incident.

An online application, via the HUG intranet, allows an incident report to be filed from any workstation.

On average, 6,000 incidents are reported each year. They cover all activities: patient care but also logistical approaches.

This procedure enters into the framework of risk management at HUG.  It is complemented by the management of serious adverse events, for which the accident report is obviously required and can lead to administrative penalties.

Analysis of these situations is a valuable source of information that is useful to improving care safety.

Patient Information

Care divisions are encouraged to offer their patients relevant and accessible information documents. They are guided and supported in this high-quality brochure and video design work, in accordance with international standards in effect, by the patients and relatives information group (GIPP) that includes doctors, nurses and health communication specialists.
Documents produced are scientifically validated and tested with patients.

Care Quality Indicators

To measure  their performance by comparing it with other institutions, HUG uses dashboards. These are decision support tools to guide strategic choices and monitor improvements to be made. 

HUG is also obligated to provide data: 

  • to the State of Geneva: in the services contract, indicators are listed in five activity areas (services to patients, clinical organization, medical-technical, human and financial resources) and include eight indicators used by H+
  • To the federal authorities: the revised Health Insurance Act requires data communication in six indicators (should the list of indicators be stated?)  

Eight H+ indicators

As an H+ member, HUG uses the eight indicators of the  National Organization of Hospitals, Clinics and Swiss Public and Private Health Care Institutions:  

  • Hospital-Acquired Infection: HUG remains within international standards (10.5% in 2009. Target: a rate lower than 10%
  • Mortality according to the methods of the Federal Office of Public Health (FOPH) and HELIOS (concept developed by clinics in Germany).
  • Number of cases by medical discipline: according to FOPH medical statistics
  • Falls:   fall rate (4.3 falls per 1000 patients in 2009)
  • Bedsores: in 2010 HUG registered a bedsore rate of 9.8%
  • Re-hospitalization: HUG is taking part in a project by the ANQ (National Quality Agency) and H+ to develop a preventable readmissions indicator for all hospitals.  Target: achieving a rate less than 6%
  • Complications: under the project from the ANQ and H+, a re-operation rate indicator is being calculated for a sample of Swiss hospitals of which HUG is a part of.

Patient-Oriented Quality

Established in 2012, the Patient-Oriented Quality Project (QuaP) helps teams improve care quality for their patients by promoting the sharing of knowledge and experiences. By June 2013, all care units will be visited by work units made up of senior staff members where at least one in the pair will be a doctor or nurse. These visits aim to: promote exchange between front line and senior staff members; identify unit strengths; uncover areas of improvement; re-sensitize staff to best practices; contribute to a common vision of quality.

 

Quality Day

HUG Quality Day has been in existence since 1999. It aims to stimulate, encourage, support and promote projects initiated by staff to improve quality of care, services and divisions.

At the end of this day, a Quality Prize is awarded by the jury to a team or person having completed a quality improvement project.

Up until 2004, only medical and care divisions could present projects. Aware that there are many other activity sectors that work to improve quality, organizers decided to expand the event to all HUG divisions. Quality Day now is a reflection of all the steps taken within the establishment. Medical services, nursing services, multidisciplinary health professionals, common services and operational services are invited to submit their projects, implemented or not, ideas and "dreams" related to the patient.