Vurdering av elementer som kan inngå i et nasjonalt kvalitetssystem for primærhelsetjenesten

Abstract

The Norwegian Knowledge Center for the Health Services was commissioned by The Department of Health and the Directorate of Health, to survey and recommend elements to be included in a national quality system for the primary health services. These are the main recommendations from the present report:  The goals for a national quality system for the primary health care should be documentation and visibility of quality, learning and quality improvement in a coordinated way, in all four levels of services; the health care worker /patient level, the health organizational level, the municipality level and the national level.  In order to efficiently contribute to quality improvement, a partnership model for development and implementation should be adopted, with involvement of patients and users, and all stakeholders in the process.  Patients and users need available and understandable information about quality of the services, and should to a larger extent than today be given the opportunity to query information on quality and safety, and contribute in the development of quality of the services.  The quality of the services should be measured and visualized in a way that is useful for patients and health workers own quality improvement work.  The development of quality indicators for all services in primary health care is an essential element of a national quality system. These should be developed according to the principles outlined in the report: Conceptual Framework for a National Healthcare Quality Indicator System in Norway - Recommendations (8).  The lack of IKT programmes, equipment, coordination and functions in relation to possible retrieval, processing, and analysing data is a major obstacle for documentation of the quality of the services.  In order to compare measures for quality through benchmarking, structured and goal oriented processes need to be in place in each of the services. This can be done in relation to local challenges, or by regional or national processes.  Leaders on the national and municipality levels, and the leaders of the individual services, should to a larger extent than today query about quality of the services and make sure documentation of quality is in place. Annual quality reports from the individual services and the municipalities. In addition there is 9 Key messages a need for more focus on patient safety, and a system for registering unwanted incidents may be established, as it is in the specialized health care services. The focus for such a registry should be on understanding the mechanisms and learning.  To have the right competence in place is important to ensure and develop quality in the primary health care services. Both professional knowledge and quality improvement knowledge is important to ensure and develop quality of the services. Knowledge and skills in both evidence based practice and quality improvement is should to a larger extent than today be included in the basic education of health care workers, as well as in their postgraduate further education.  More research is needed about quality improvement in the primary care sector. Improvement projects should be followed by evaluation, as should the implementation of a national quality system in the primary care services.  To give push, pull and direction in the quality documentation, visualization and improvement work, we propose establishing a unit with particular responsibility to develop and implement at national quality system for the primary health services. Such a unit needs to coordinate and further develop the work already in place today, and establish technical and process support for the locally based quality improvement work. The main focus of the work should be learning and quality improvement, and user involvement is understood.  Anchoring the work in the health laws would be a tremendous help in getting increased focus and resources for an increased and coordinated effort towards better quality.