Policy-makers need to implement a broad range of coherently aligned mechanisms to have a chance at improving quality of care. The European Observatory on Health Systems and Policies ran a series of webinars covering three examples of such mechanisms, inspired by a comprehensive study on improving health care quality in Europe.
Zooming into structures, processes and outcomes of care, the series explored the role of health technology assessment (HTA) and the potential of cross-country collaboration, different contributors to the development and implementation of clinical guidelines, and the opportunities and challenges of paying for quality (P4Q) programmes in health systems across Europe and beyond.
Quality of care experts from the Observatory, the World Health Organization (WHO), the European Commission’s Joint Research Centre, national health authorities and other institutions from Europe and the US discussed key policy questions associated with quality of care, bringing together evidence from research and country experiences.
Interconnectedness and context are key
For example, the potential of HTA in improving quality of care lies in adopting valuable innovation and removing obsolete technologies. Clinical guidelines can influence care outcomes, but they need to be disseminated effectively to inform care processes on the ground. And P4Q schemes are increasingly used to provide incentives to health care providers based on the measured quality of care.
In addition, evidence on health technologies synthesized in HTA can inform clinical guidelines, and guidelines themselves can be used as a basis to develop indicators for the measurement of outcomes in P4Q schemes.
The webinars brought home the message that implementing HTA alone, or clinical guidelines alone, or P4Q programmes alone will not be sufficient to achieve quality of care.
“Through the series we were able to show the interconnectedness between different mechanisms,” explains Dimitra Panteli, Programme Manager at the Observatory who led the series. “There are dozens of initiatives and mechanisms that aim to improve quality of care, and we only explored three. We need an overall strategy that understands how different mechanisms fit together, and we need to consider that a mechanism that works in one setting may well not work in another”.
Supporting decision-making in different settings
For policy-makers who struggle to decide which initiatives to prioritize for investment, understanding the potential of different quality mechanisms in their unique settings is key.
The study, published by the Observatory in collaboration with OECD, not only summarizes available evidence on different quality mechanisms but also provides recommendations for their implementation.
Reinhard Busse, Co-Director of the Observatory in the Berlin hub and editor of the book that inspired the series, explains: “Quality improvement initiatives take many forms, from audits and feedback to fostering a patient safety culture and public reporting. It is important that we learn from each other and see what works in different contexts.”
By so doing, this book is designed to help policy-makers prioritize and align different quality initiatives and to achieve a comprehensive approach to quality improvement.
New WHO European Centre of Excellence for Quality in Care and Patient Safety
The Observatory’s series of work on quality of care interestingly coincided with the launch of WHO’s new European Centre of Excellence for Quality in Care and Patient Safety. Based in Athens, Greece, it aims to support countries in improving quality of care while focusing on innovation for quality within health systems.
The Centre was set up as part of the response from the WHO Regional Office for Europe to challenges posed by COVID-19, explains João Breda, who leads the new office: “Quality has been part of discussions, but it emerged during the pandemic as more important than ever before. From prevention to palliative care, quality of care helps us improve wellbeing and health systems performance leaving no one behind. There is no Universal Health Coverage without quality.”
As a knowledge brokering institution, the Observatory plans to collaborate closely with the new Centre by working together with policy-makers to understand the mechanisms that help improve quality of care.