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Jean Petit of the University Hospital Centre of Rouen

by Lloyd Davis

Background: Chief Medical & Quality Assurance Officer, University Hospital Centre of Rouen, France.

The first point that comes to mind about quality of patient management is the evolution of this concept over the last 200 years. In the 19th century we were dealing with fatality, providing compassionate care; then handling disease, and offering experiences and opinions. This paternalistic model has changed for three reasons: evidence-based medicine, interdisciplinarity, and patient empowerment. Patients will increasingly become partners of the professionals and the industry will have a shared model of decision-making.

Information and decision-making will become more symmetrical.

This is a movement that is desirable and irreversible. Consumer awareness is awakening. Television, the internet and access to clinical records promote this. Patient empowerment allows patients to voice their opinions one of which is a dislike for the paternalistic approach of clinicians. So we’re now seeing laws to confirm what people are entitled to.

The WHO has developed criteria to measure the responsiveness of respective countries’ healthcare systems. The criteria includes: dignity, autonomy, confidentiality, prompt attention, basic amenities, choice, and social care. France is 16th in this list while the UK is 26. The top: USA followed by Switzerland.

Quality care has many dimensions:
ability to provide
overall satisfaction
We have to pay attention to patients’ rights, e.g. the charter for hospitalised individuals. See www.sante.gouv.fr which covers the rights to respect choice, and privacy , as well as access to information.

Professional guidelines, supported by evidence-based medicine, are important too. New information systems will increasingly have these guidelines embedded.

A few words about accreditation - valuable reforms have been introduced to standardize quality in health care organizations (HCOs). Initially 25% of HCOs reviewed were found to have quality concerns on the first visit of assessors; 85% of which were addressed on the second visit. The role of users and their advocates are also important in accreditation.

There’s no quality without measures. In terms of health care and satisfaction, it is now possible to measure processes and outcomes. Emotional arguments, while compelling, are not the solution. By using performance indicators, France has a method of benchmarking successes.

I want to just tell you about a some voluntary strategic initiatives: e.g. Saphora, a nationwide satisfaction inquiry conducted in University Hospitals. Another example: patient-centered quality improvement programs such as hearing tests among older people.

1 Comment »

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