Performance management, developing a culture of measurement and continuous quality improvement in Estonian hospitals

Autorid: Guisset A-L , Kjaergaard J , Habicht J
Väljaandja/tellija: WHO Regional Office for Europe
Märksõnad: haiglad, tervishoid, terviseteenused, tervishoiukorraldus
Välja antud: 2009
Avaldamise koht: Copenhagen
Tüüp: Uuring/analüüs
Nimi SuurusFormaat
Guisset2009.pdf633.56 kBAdobe PDF
Alamvaldkonnad:Terviseteenuste korraldus, kättesaadavus ja kvaliteet
Kirjeldus: Estonia is currently at a crossroads in hospital performance management. In 2001, the country embarked on hospital governance reform with the introduction of new management structures (management boards and supervisory boards). Other initiatives and reforms have been implemented over the last years to hold hospitals accountable for measurable results and to foster a culture of continuous quality. Estonia joined the performance assessment tool for quality improvement in hospitals (PATH) network for its second wave of data collection and analysis in 2007 (PATH-II). The PATH coordination is assured by the Estonian Health Insurance Fund (EHIF). Its involvement in PATH is motivated by its objective to support and promote comprehensive development of health care in Estonia, in addition to its core financing of health services. The EHIF aims to "purchase not only quantity of services but also quality of services by means of e.g. fine-tuning contracts with a quality clause, supporting the development and implementation of clinical guidelines, performing clinical audits, and developing pay-for-performance incentives. This report aims to first to review whether or to what extent these changes have improved performance management practices.
Also, there is currently growing interest in the development of an indicator system in Estonia - building on PATH experience - but questions have been raised about potential use and abuse of such tools and how to position them. The objectives and roles of the different stakeholders have not been clarified. At this point, the report aims to foster debate incorporating perspectives of the different stakeholders on the issue of the National Indicator System (or similar approaches), in the wider context of governance and performance assessment practices in hospitals. Hence, the study aims to analyze the governance and management practices in hospitals, the current use of performance1 indicators in hospital and the national stakeholders' views of them, to assess national stakeholders' local technical capacities for coordination, data analysis, and evidence-based, strategic decision-making, and to highlight strengths and weaknesses of indicator systems in supporting hospital performance management.