ALMANYA VE TÜRKİYE’DE SAĞLIKTA KALİTE İNDİKATÖRLERİ VE BEKLENMEYEN OLAY YAKLAŞIMLARI ÜZERİNE BİR DERLEME

Abstract

Hasta güvenliğini sağlamak amacıyla kalite çalışmalarının değerlendirilmesi kalitenin ölçülmesi ile mümkün olmaktadır. Kalitenin ölçülmesi için “Kalite İndikatörleri” kullanılmaktadır. Kalite indikatörlerinin belirlenmesi ve gerçekçi ölçümlerin yapılabilmesi için ise bu indikatörler temelinde ortaya çıkmış olan beklenmeyen olayların tespit edilmesi ve bildirilmesi neticesinde kalitenin ölçülmesinin mümkün hale gelmesi sağlık sistemlerinin geliştirilmesi için çok değerli sonuçlar ortaya koymaktadır. Bu çalışmada “Sağlıkta Kalite Uygulamaları” kalite indikatörleri ve beklenmeyen olaylar odağında, Avrupa Birliği üyesi ve gelişmiş ülke konumundaki Almanya ile Avrupa Birliği yolunda ilerleyen ve gelişmekte olan bir ülke konumundaki Türkiyekarşılaştırılmıştır. Çalışmada Sağlıkta Kalite Uygulamalarının karşılaştırmalı değerlendirme neticesinde tanınması, iki ülkenin kalite indikatörleri ve beklenmeyen olaylara yaklaşımlarının olumlu ve olumsuz yönlerinin tartışılması ve uygulama güncellemeleri için alternatif olabilecek yöntemler önerilmesi amaçlanmıştır. Sonuç olarak; Almanya’da Kalite Programı “Geniş Katılımlı Veri Temelli Kalite Programı” olarak tanımlanabilir. Almanya’da Beklenmeyen Olay Bildirimleri için hastaneler özendirilmekte, kaliteye yöneltilmekte, sağlık hizmetinde kalite rekabeti oluşturulmaktadır. Ancak ödemeler ve finansal kaygılar göz önüne alındığında bu rekabetin sadece kalite göstergelerinin halka ulaştırılmasıyla sağlanamayacağı hissedilmektedir. Türkiye’de kalite indikatörlerinin kullanılmasını sağlayacak sistemde çok iyi bir seviye yakalanmış olmasına rağmen beklenmeyen olay bildirimi, kalite indikatörlerinin işletilmesi ve sonuçların paylaşılması hususlarında aksaklıklar hissedilmektedir.

Keywords

• sağlıkta kalite
• sağlıkta kalite indikatörleri
• beklenmeyen olay

A REVIEW ON HEALTHCARE QUALITY INDICATORS AND UNEXPECTED EVENTS APPROACHES IN GERMANY AND TÜRKİYE

Abstract

Evaluation of quality studies in order to ensure patient safety is possible by measuring quality. "Quality Indicators" are used for this. In order to determine indicators and for realistic measurements, detecting and reporting unexpected events that have arisen on the basis of these indicators reveal invaluable results for the development of health systems.Germany, which is a developed country and a member of the European Union, and Turkey, which is a developing country on the way to the European Union, were compared in the focus of quality indicators and unexpected events in focus of “Quality Practices in Healthcare” in study.It is aimed to recognize the Quality of Health Care as a result of comparative evaluation, to discuss the positive and negative aspects of the two countries' quality indicators and their approaches to unexpected events, and to suggest alternative methods for application updates.In conclusion; In Germany, the Quality Program can be defined as a "Data-Based Quality Program with Wide Participation". Hospitals are encouraged for Unexpected Event Notifications in Germany, they are directed towards quality, and quality competition which created in healthcare services. However, when the payments and financial concerns are taken into consideration, it is felt that this competition cannot be achieved only by publishing the quality indicators to the public. Although a very good level has been achieved in the system that will enable the use of quality indicators in Turkey, there are problems in unexpected event notification, use of quality indicators and sharing of results.

Keywords

• health care quality
• health care quality indicators
• unexpected event

References

1. Colón G. D. R., Wu A., Ratliff J.K., Prolo L. M. Quality and patient safety research in pediatric neurosurgery: A review. Child's Nervous System. 2023;39:1147-1158. doi:10.1007/s00381-022-05 821-z.
2. Agbar F., Zhang S., Wu Y., Murtada M. Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis. Nurse Education In Practice. 2023;67:103565. doi:10.1016/j. nepr.2023.103565.
3. Zabin L.M., Zaitoun R.S.A., Sweity E.M., Tantillo de L. The relationship between job stress and patient safety culture among nurses: A systematic review. BMC Nursing. 2023;22(1):39. doi:10.1186/s12912-023-01198-9.
4. Goekcimen K., Schwendimann R., Pfeiffer Y., Mohr G., Jaeger C., Mueller S. Addressing Patient Safety Hazards Using Critical Incident Reporting in Hospitals: A Systematic Review. Journal Of Patients Safety. 2023;19(1):e1. doi:10.1097/PTS.0000000 000001072.
5. Quality of care. World Health Organization. [Online] 06 13, 2023. https://www.who.int/health-topics/quality-of-care#tab=tab_1.
6. Elation. What exactly does quality mean in the healthcare context? Elation. [Online] 06 13, 2023. https://www.elationhealth.com/resources/blogs/what-exactly-does-quality-mean-in-the-healthcare-context.
7. Vuk T. Quality indicators: A tool for quality monitoring and improvement. ISBT Science Series. 2012; 7(1):24-28. doi:10.1111/j.1751-2824.2012. 01584.x
8. Schang L., Blotenberg I., Boywıtt D. What makes a good quality indicator set? A systematic review of criteria. International Journal for Quality in Health Care. 2021;33(3):1-10:mzab107. doi:10.1093/intq hc/mzab107.

9. Joint Commissionn International. [book auth.] JCI. 2021;173-178. JCI Acreditation Standarts (General Hospitals) Illinois.https://www.jointcommission international.org/-/media/jci/jci-documents/accreditation/hospital-and-amc/jci-errata-standards-only_7th-ed-hospital.pdf
10. Akgün S. Hasta Güvenliği, Beklenmeyen Ciddi Tıbbi Hatalar -Sentinel Olaylar-Sentinel Events in Healthcare. Sağlık Akademisyenleri Dergisi. 2014;1(2):75-82. https://dergipark.org.tr/tr/pub/sagakaderg/issue/46755/586410#article_ cite
11. Fernando S., Bandara T., Makani P. Are Incident Reporting Systems in Healthcare Systems a Requirement for Improving Patient Safety? A Review. International Journal of Health Systems Resilience. 2023;(2):1-10. doi:10.51595/INJHSR22/ 019.
12. Koca M., Köksal A., Deniz S. A Cross-sectional Investigation of Physicians' Perspectives on Clinical Quality Practices in a Training and Research Hospital. Journal Of Health Institutes of Turkey.2023;(6):1-7. doi:10.54537/tusebdergisi.1213118.
13. European Union. SO WHAT? Strategies across Europe to assess quality of care. Luxembourg : Publications Office of the European Union, 2016.
14. Der Gemeinsame Bundesausschuss. (The Federal Joint Committee: Who we are and what we do). [Online] 06 08, 2023. https://www.g-ba.de/english/structure/.
15. The legal status of the G-BA. G-BA. Official. [Online] 06 09, 2023. https://www.g-ba.de/downloads/17-98-2850/GBA_Rechtsstellung_08-04-2013_engl.pdf.
16. The Federal Joint Committee. Who we are and what we do for your health. s.l. : Gemeinsamer Bundesausschuss, 2022.
17. The AQUA Institute. SQG. [Online] 06 09, 2023. https://sqg.de/front_content.php?idcat=170.
18. IQTiG. Organisation der Stiftung. IQTiG. [Online] 06 10, 2023. https://iqtig.org/das-iqtig/wer-wir-sind/organisation-der-stiftung/.
19. IQTiG Was wir tun. Was wir tun. IQTiG. [Online] 06 10, 2023. https://iqtig.org/das-iqtig/was-wir-tun/.
20. IQTiG Datenerfassung und Auswertung. Datenerfassung und Auswertung. IQTiG. [Online] 06 11, 2023. https://iqtig.org/qs-instrumente/planungs relevante-qualitaetsindikatoren/.
21. Pross C., Geissler A., Busse R. Measuring, Reporting, and Rewarding Quality of Care in 5 Nations: 5 Policy Levers to Enhance Hospital Quality Accountability. The Milbank Quarterly. 2017;95(1):136-183. doi:10.1111/1468-0009.12248.
22. Bayındır E.E., Schreyögg J. Public Reporting Of Hospital Quality Measures Has Not Led To Overall Quality Improvement: Evidence From Germany. Health Aff. 2023;42(4):566-574. doi:10.1377/hlt haff.2022.00470.
23. Republic of Türkiye ministry of health. Sağlıkta Dönüşüm. Ankara : TC Sağlık Bakanlığı, 2003.
24. General Directorate of Health Services of Ministry of Health, Department of Health Quality, Accreditation and Employee Rights. TC Ministry Of Health. [Online] TC Ministry Of Health, 2023. [Cited: 12 10, 2023.] https://shgmkalitedb.saglik.gov.tr/TR,6031/mevzuat.html.
25. SKS Hastane. Ankara : TC Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü, 2020.
26. OECD. OECD. [Online] 06 14, 2023. https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH _HCQI#.
27. Republic Of Türkiye Ministry of Health. SKS Serious Of Patient. Prevention of hospital related thromboembolism. Ankara : (Republic Of Türkiye Ministry of Health) https://shgmkalitedb.saglik. gov.tr/Eklenti/44559/0/01hastane-iliskili-venoz-tromboemboliler-rehberi--10122022pdf. 2022,p. 9.
28. Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health System Review. Health Syst Transit. 2020;22(6):1-272.https://pubmed.ncbi.nlm.nih.gov/34232120