Research News

A systematic approach to develop a core set of parameters for boards of directors to govern quality of care in the ICU

International Journal for Quality in Health Care, Volume 30, Issue 7, 1 August 2018

Abstract

Objective

Hospital boards are legally responsible for the quality of care delivered by healthcare professionals in their hospitals, but experience difficulties in overseeing quality and safety risks. This study aimed to select a core set of parameters for boards to govern quality of care in the intensive care unit (ICU).

Design

Two-round Delphi study.

Setting

Two university hospitals in the Netherlands.

Participants

An expert panel of 12 former ICU patients or their family members, 12 ICU nurses, 12 ICU physicians and 12 members of boards of directors and quality managers.

CARE NEEDED: Improving the Lives of People with Dementia

EXECUTIVE SUMMARY

Dementia is a dreadful disease and a growing global challenge. The number of people living with dementia across the OECD reached nearly 19 million people in 2017, while millions of family members and friends provide care and support to loved ones with the condition throughout their lives. Beyond the personal and emotional toll of dementia, its financial costs are vast. The worldwide health and social costs of dementia were estimated to reach USD 1 trillion per year in 2018. Dementia is strongly associated with age. This makes the ageing of the population in many OECD countries the main factor associated with the growing dementia prevalence. As the share of the population aged above 80 years continues to rise, and until a cure or disease modifying treatment is found, the number of people living with dementia will continue to grow, and is likely to reach nearly 41 million people in the OECD by 2050.

Despite significant research efforts, much about the condition remains a mystery. No treatments have yet been developed that can effectively cure or halt the progression of dementia. Many recent late stage clinical trial failures have frustrated efforts and investment by the pharmaceutical industry. Further, today, too many people living with dementia go without a diagnosis. Even when they may be diagnosed, care systems are often fragmented, and the stigma surrounding dementia has led many people to believe that
nothing can be done.

Yet the lack of a cure does not mean that there are no options. A range of beneficial services are available that can improve the health and quality of life of people living with dementia. However, in many cases, too few people have been able to access them. OECD countries urgently need to improve access to and quality of these services.

In recent years, dementia has received growing attention as governments begin to recognise the scope of the challenge ahead. As many as 22 OECD countries have developed national plans and strategies for addressing dementia, and have moved to make diagnosis and follow-up care more accessible and of higher quality. Treatment and care services can be further improved, and better monitoring and comparing of processes and outcomes will play an important role.

Measuring Health and Economic well being in the Sustainable Development Goals Era

Measuring health and economic well being in the Sustainable Development Goals era: development of a poverty-free life expectancy metric and estimates for 90 countries

The purpose of this article published in The Lancet is to propose a poverty-free life expectancy (PFLE) as a new metric to provide a composite measure of population health and economic well-being. As part of the Sustainable Development Goals, which emphasize the link between health and development policies, it responds to a need of having a monitoring tool that incorporate measures of both health and economic status. The authors computed the PFLE for 90 countries and interpreted the results.

SUMMARY

Background

The Sustainable Development Goals (SDGs), adopted in September, 2015, emphasise the link between health and economic development policies. Despite this link, and the multitude of targets and indicators in the SDGs and other initiatives, few monitoring tools explicitly incorporate measures of both health and economic status. Here we propose poverty-free life expectancy (PFLE) as a new metric that uses widely available data to provide a composite measure of population health and economic wellbeing.

Methods

We developed a population-level measure of PFLE and computed this summary measure for 90 countries with available data. Specifically, we used Sullivan's method, as in many health expectancy measures, to incorporate the prevalence of poverty by age and sex from household economic surveys into demographic life tables based on mortality rates from the 2015 Global Burden of Disease Study (GBD). For comparison, we also recalculated all PFLE measures using life tables from WHO and the UN. PFLE estimates for each country, stratified by sex, are the average number of poverty-free years a person could expect to live if exposed to current mortality rates and poverty prevalence in that country.

Findings

The average PFLE in the 90 countries

What is the experience of decentralized hospital governance in Europe?

Hospitals in Europe face many challenges, including cost pressures, technological changes, an evolving burden of disease, growing patient expectations, political pressure on public authorities to restructure traditional governance models and, in some countries, increasing competition from the private sector

Hospital governance has received particular attention, reflecting the growing number of political, financial and technical, as well as social and professional, factors that affect decision-making in the hospital sector. Reforms have introduced different models of hospital governance in different European countries.

This policy brief provides an overview of 10 case studies from Western Europe on macro-level arrangements in hospital governance – the structural, organizational and operational architecture of the health system. The aim is to compare the experience of decentralized hospital governance to inform policy-making as there have been concerns about the tradeoffs involved.

The concept of hospital governance represents a relatively new approach to hospital-related policy and health policy analysis. Its emergence since the early 2000s reflects the growing number of political, financial and technical, as well as social and professional, factors that affect hospital sector decision-making. Reforms have introduced different models of hospital governance in different European countries.

Hospital governance conceptually encompasses three increasingly blurred levels of hospital-related decision-making, in the context of each health system. The main "entry point" for this policy brief is the macro-level, mostly government-based, aspect of governance rather than the day-to-day operational management of the micro-level or institutional decision-making at the meso-level. One of the key processes has been an increasing decentralization of the macro-governance of public hospitals, and the role of the private sector has also increased in many countries.

TRANSFORMING HEALTH CARE DELIVERY Achieving Better Outcomes and Affordability

Taking the patients' perspective and putting their needs at the center sets the stage for a shift in health care delivery and even a redefinition of what falls under the purview of health care. Physicians and other clinicians will have to embrace new ways of working together, integrating the role of technology and teamwork in delivering multidisciplinary, data-informed care. Technology partners play a key role in supporting and innovating to improve access to effective, affordable care. Working cooperatively with patients on their needs, preferences and goals will result in a health care system that can deliver affordable care and optimal outcomes for patients' evolving needs.

The American Hospital Association invited hospital administrators and health care leaders to this event sponsored by Siemens Healthineers to learn innovative strategies and technologies that put patients at the center, break down barriers and bring care closer to home.

Access the whole document Transforming Health Care Delivery