澳大利亚医疗质量管理对中国的启示

澳大利亚非常注重加强质量改善和安全管理,制定统一和可行的标准和评价指标,并将质量和安全问题纳人日常的工作计划和战略管理规划中予以实施。政府在医疗质量管理中起到非常重要的作用,而且非常重视患者和社区对医疗质量的参与度。本文通过探讨澳大利亚医疗质量管理体系及其服务理念和质量管理经验,探讨澳大利亚的经验对我国医疗质量管理的借鉴。     

ISO9004服务质量体系在医院质量管理中的应用

随着医疗卫生服务改革的深入，医院的发展与生存已成为医院管理者面临的一个重大问题。为了适应不断变化的医疗市场，满足人民群众对医疗保健日趋增长的需求，医院必须建立一个具有战略性的质量管理体系，以确保医院管理思想和方法不断进步。为此，自1999年我院率先应用了ISO9004国际标准质量管理体系，并先后进行了两次换版。在几年来的实践应用过程中，医院在医疗服务质量方面取得了明显的效果，下面就我院在实施ISO9004标准过程中的做法和体会总结如下。     

军队医院实施ISO 9001体系认证的思考

现代医院均强调“以病人为中心，以质量为核心”开展医疗工作。军队医院实施ISO9000体系认证的目的是想引进现代质量管理的科学理念和先进方法，建立较为完善的医院质量管理体系，使医疗服务工作的各个环节都处于受控状态，减少质量缺陷，将“以病人为中心”的医疗理念真正融人医疗工作的每一环节，提高医疗保健水平，打响医疗服务牌。     

医疗质量管理体制的建立与运用

本详细阐述了医疗质量管理体系的基本要素,即：医疗质量管理的组织、医疗质量管理的标准、医疗质量的监控与评价和医疗质量评价结果的正确利用,并结合本院的工作实践,介绍了加强医疗质量管理工作的主要做法：①健全医疗质量管理组织和网络,实现全员质量监控;②制定并完善了有关质量管理标准和办法,实行规范化管理;③实施全程、动态质量监控,精心组织质量考评等等。     

再谈全面医疗质量管理的实施

文章对全面医疗质量管理的时代背景和管理体系的建立进行分析，提出了质量仍然是医疗质量管理的核心，在实施行之有效的全面医疗质量管理的基础上积极借鉴医疗管理方面新的思想方法和技术，并融入到全面医疗质量管理之中。全面医疗质量管理仍然是国内常用的医疗质量管理方式。     

医疗质量管理委员会对医院管理持续改进的效能研究

目的：研究笔者所在医院质量管理委员会的效能与持续改进效果。方法：对2008-2011年医疗质量管理委员会的管理情况进行分析。结果：根据医院管理年评价体系标准,建立院、科两级管理体系,医疗质量管理委员会发挥持续改进优势作用,病历书写质量明显提高,诊疗行为进一步标准规范,医疗纠纷率下降,患者满意度提高。结论：完善医疗质量管理委员会的功能与职责,推进制度执行能力;改善院级质控方式,提升质控有效性。促进医疗质量持续改进。     

加强领导 强化措施我市干部医疗服务管理工作取得新进展

为切实强化干部医疗服务管理，推动干部保健工作的顺利开展，2005年1月10日-13日，市保健委员会办公室组织4名保健专家，对市直2家干部医疗保健基地和12家干部保健定点医疗机构2004年度的干部医疗服务管理工作进行了考核。从考核情况看，各干部医疗保健基地和定点医疗机构自2004年7月5日经市保健委员会办公室验收获得准入资格后，特别是市直干部医疗保健定点医疗机构管理工作会议之后，各干部医疗保健基地和定点医疗结构认真履行与市保健委员会办公室签订的“医疗保健服务协议”，严格执行市保健委员会办公室下发的《泰安市干部医疗保健定点医疗机构管理暂行办法》、     

澳大利亚乳腺癌早诊早治项目管理

从癌症预防、治疗和质量管理等多个角度对澳大利亚早期乳腺癌肿瘤预防与控制概况予以描述,分析乳腺癌早诊早治的项目管理的成功经验,包括建立质量管理体系,实施多学科诊疗服务模式及质控标准,努力改善医疗工作绩效,为我国早期乳腺癌的防控工作提供借鉴,提高乳腺癌的诊疗服务水平。     

实施ISO质量管理体系对医疗质量的促进

目的医院实施ISO9001:2000版质量管理体系,规范科室管理,提高医疗护理质量。方法在科室全体员工中贯彻ISO质量管理体系,对影响我科医疗护理质量的关键环节进行控制。结果体系运行四年来,我科医疗护理质量明显提高,患者满意率逐年提高,医患纠纷逐年下降。结论ISO9001:2000版标准质量管理体系,对我科医疗护理质量具有明显的促进作用。     

标准操作程序在医学装备质量管理体系的应用

目的:设计医院医疗设备质量管理体系,实现对质量控制工作的标准化、规范化、统一化管理。方法:结合企业先进、实用的管理方法,提出医院医学工程科有效开展医疗设备质量管理的新方法。结果:通过实验,对所得数据进行统计分析,提出医疗设备标准操作程序(SOP)质量管理体系,并引入计划、实施、检查和处理(PDCA)不断循环的动态管理。结论:SOP方法的实施,可以有效改善医疗设备的质量管理,改善医院发展的前景,减少医院医疗设备管理成本,提高医院医学工程科管理效能。     

Influencing population health performance: introduction of standards for area health services in New South Wales

Standards are a yardstick against which performance can be assessed and improved. Standards are well established in healthcare settings; however, population health standards have only recently been developed for area health services in NSW. This paper describes international and Australian population health standards, and presents the results of a pilot evaluation of the NSW Population Health Standards for Area Health Services against the Greater Western Area Health Service performance requirements. The findings revealed that the standards relating to the work of specialist population health staff feature in performance requirements; however the standards requiring the contribution of other health service staff do not. Population health standards have the potential to guide the health system towards population health goals.     

The Chronic Care for Aboriginal People program in NSW

Aboriginal people living in NSW continue to experience greater health risks, poorer health and shorter life expectancies than non-Aboriginal Australians. The NSW Health-funded program, Chronic Care for Aboriginal People, was established from existing initiatives to rethink the way chronic care services were delivered to Aboriginal people in NSW. Refocusing and building on existing projects led to NSW Health providing an evidence base of what was working in Aboriginal communities. A model of care for Aboriginal people with chronic disease has been developed. Recommendations from two evaluations have allowed further improvement for the delivery of chronic care services for Aboriginal people. The Local Health District Service Agreements include relevant indicators and strategic priorities relating to the chronic care program.     

Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service

Objective: In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co‐morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co‐morbid D&A and mental health disorders. Design: Current literature on co‐morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. Setting: A rural Area Health Service in NSW. Participants: Rural health and welfare service providers, consumers with co‐morbid D&A and mental health disorders. Results: Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug‐taking. Information gathered from the focus groups indicated a reasonable level of awareness of co‐morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Discussion: Significant gaps in the provision of appropriate care for people with co‐morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co‐morbid care can be provided.     

The oral health care experiences of NSW Aboriginal Community Controlled Health Services

Objectives: Aboriginal people continue to experience a disproportionately heavy burden of oral disease. A range of oral health services may be available to Aboriginal communities, including those provided by Aboriginal Community Controlled Health Services (ACCHSs). This study explored the oral health care experiences and activities of ACCHSs to inform policy and program decision making. Methods: Mixed methods, including an online survey and semi‐structured interviews with senior ACCHS staff, were used. Areas of inquiry included perceived community need for oral health care, oral health care models, accessibility of other oral health services and barriers to providing oral health care. Twenty‐nine NSW ACCHSs participated in the study. Results: The activities of NSW ACCHSs in oral health care are diverse and reflect the localised approaches they take to delivering primary health care. ACCHSs commonly face barriers in delivering oral health care, as do Aboriginal communities in accessing other oral health services. Conclusion: NSW ACCHSs are important but under‐acknowledged providers of a range of oral health services to Aboriginal communities and are well placed to provide this care as part of their comprehensive primary health care model. Implications: ACCHS roles in improving Aboriginal oral health would be strengthened by greater acknowledgement of their contributions and expertise and the development of transparent, long‐term funding policies that respond to community need.     

Collecting and using aboriginal health information in New South Wales

OBJECTIVE: To describe the development of guidelines for the management of Aboriginal health information in NSW. The purpose of the guidelines is to promote the ethical management of Aboriginal health information, with appropriate consideration for cultural factors. METHODS: The guidelines were developed collaboratively by the NSW Aboriginal Health Partnership, which comprises NSW Health (the central administrative office, named NSW Department of Health, and the Area Health Services) and the NSW Aboriginal Health and Medical Research Council (AHMRC), the peak body representing member Aboriginal Community Controlled Health Services in NSW. A lengthy and comprehensive consultation process enabled a wide range of interested groups to have input into the guidelines. RESULTS: The project culminated in the production of the NSW Aboriginal Health Information Guidelines, covering the collection, ownership, storage, security, release, usage, interpretation and reporting of information, as well as issues of privacy and confidentiality. The Guidelines formed the basis of a formal Memorandum of Understanding, signed by the NSW Minister for Health, NSW Department of Health and the AHMRC, on 24 August 1998. CONCLUSIONS AND IMPLICATIONS: The Guidelines make an important contribution to meeting a need for protocols on the collection, ownership and use of Aboriginal health information. Their production reflects successful collaboration between government and Aboriginal Community Controlled Health Services in NSW. Future reviews of the Guidelines will ensure their effectiveness and consistency with Aboriginal community principles.     

A health impact assessment of the Liverpool Hospital redevelopment

This case study describes the process and results of a prospective health impact assessment that was conducted on a major hospital redevelopment in NSW. Undertaking the health impact assessment has raised awareness of the potential intended and unintended consequences of redevelopment in relation to health. It has also enhanced the capacity and commitment for health impact assessment within the Area Health Service.     

A case study of enhanced clinical care enabled by Aboriginal health research: the Hearing,EAr health and Language Services (HEALS) project

Objective : To describe and evaluate Hearing EAr health and Language Services (HEALS), a New South Wales (NSW) health initiative implemented in 2013 and 2014 as a model for enhanced clinical services arising from Aboriginal health research. Methods : A case‐study involving a mixed‐methods evaluation of the origins and outcomes of HEALS, a collaboration among five NSW Aboriginal Community Controlled Health Services (ACCHS), the Sydney Children's Hospitals Network, NSW Health, the Aboriginal Health and Medical Research Council, and local service providers. Service delivery data was collected fortnightly; semi‐structured interviews were conducted with healthcare providers and caregivers of children who participated in HEALS. Results : To circumvent health service barriers, HEALS used relationships established through the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) to form a specialist healthcare network. HEALS employed dedicated staff and provided a Memorandum of Understanding (detailing mutual goals and responsibilities) for each ACCHS. Despite very tight timeframes, HEALS provided services for 653 Aboriginal children, including 5,822 speech‐language pathology sessions and 219 Ear, Nose and Throat procedures. Four themes reflecting the perceived impact of HEALS were identified: valued clinical outcomes, raising community awareness, developing relationships/networks and augmented service delivery. Conclusions : HEALS delivered rapid and effective specialist healthcare services through an existing research collaboration with five ACCHS, cooperation from local health service providers, and effective community engagement. Implications for Public Health : HEALS serves as a framework for targeted, enhanced healthcare that benefits Aboriginal communities by encapsulating the ‘no research without service’ philosophy.     

Developing better casemix education for rural New South Wales

ABSTRACT: Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.     

Robust data to close the gap: current vascular and maternal/newborn indicators as measures of progress in Aboriginal health in New South Wales

Objective: Focussing on maternal/newborn health and vascular diseases, to review NSW Health's reporting, by Aboriginal status, against national performance indicators relevant to preventable chronic diseases. Methods: We reviewed seven indicator documents and the Australian Institute of Health and Welfare Chronic Disease Indicator Database to identify national indicators. Indicators from six NSW Health reports were then compared with these national indicators to assess reporting by Aboriginal status and region. Results: NSW Health routinely reports against six maternal/newborn indicators and fourteen vascular national indicators. Five of the former report performance by both Aboriginal status and region. Eight of the latter report by Aboriginal status, one of which (diabetes hospitalisations) also reports by region. Indicator quality and breadth was substantially limited by under‐enumeration of Aboriginal status, small or potentially unrepresentative samples, inadequate longitudinal or regional data and few primary health care indicators. Notwithstanding these limitations, we found wide and persistent disparities in outcomes for Aboriginal people for all indicators in all regions. Conclusions: NSW Health reports adequately, by Aboriginal status, for maternal/newborn health monitoring (albeit constrained by under‐enumeration), but provides limited information about vascular health. A minimum, national chronic disease indicator dataset against which all jurisdictions would report performance by Aboriginal status and region is needed. Improved monitoring requires sustained efforts to address under‐enumeration, better survey sampling, and population representative data from the primary care system.     

The purpose of occupational medicine.

The purposes of occupational medicine are described in terms of its clinical medical, environmental medical, research, and administrative content. Each of these components is essential in different proportions in comprehensive occupational health services for different industries, and can only be satisfactorily provided by occupational physicians and occupational health nurses who are an integral part of their organizations. Two-thirds of the working population in the United Kingdom are without the benefits of occupational medicine. The reorganization of the National Health Service and of local government presents the opportunity to extend occupational health services to many more workers who need them. It is suggested that area health authorities should provide occupational health services for all National Health Service staff and, on an agency basis, for local government and associated services, eventually extending to local industry. Such area health authority based services, merged with the Employment Medical Advisory Service, could conveniently then be part of the National Health Service, as recommended by the British Medical Association, the Society of Occupational Medicine, and the Medical Services Review Committee.