the organisational changes of the executive agency for medical audit bulgaria helsinki,...
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THE ORGANISATIONAL CHANGES OF THE THE ORGANISATIONAL CHANGES OF THE EXECUTIVE AGENCY FOR MEDICAL AUDITEXECUTIVE AGENCY FOR MEDICAL AUDIT
BULGARIABULGARIA
Helsinki, 29-30.09.2015Helsinki, 29-30.09.2015
BulgariaBulgaria
• Territory: 111 000 km2• Population: 7 202 198 (2014)• Ethnic distribution:• Bulgarians: 83.0%• Turks: 9.0%• Roma: 3.0%• Others: 6.0%
Republic of BulgariaRepublic of Bulgaria
In south-eastern Europe - part of the Balkan Peninsula
Bordered: NorthRomania East Black seaWest Serbia and The former Yugoslav Republic of Macedonia SouthGreece and Turkey
BulgariaBulgaria
Economic development GDP (BGN): 82.16 billion leva (2014) GDP: 42 billion Euros (2014) GDP per capita: 5 832 Euros (2014) Health expenditures per capita: 283 Euros (2014) Health expenditures as % of GDP: 3.98% (2014)
HealthHealth
Population: 7.2 million (2014) Live births: 9.4 per 1,000 population (2014)Crude death rate: 15.1 per 1,000 population (2014)
Life expectancy: 74.95 yearsMales at birth (2013): 71.3 years Females at birth (2013): 78.6 years
Executive Agency for Executive Agency for Medical Audit (EAMA)Medical Audit (EAMA)
• Established in January, 2010 with Decree of the Established in January, 2010 with Decree of the Council of Ministers as Council of Ministers as governmental institution governmental institution under the MoH’s powerunder the MoH’s power
The EAMA supervises:The EAMA supervises:• all types of healthcare establishments in the countryall types of healthcare establishments in the country• the National Health Insurance Fund (NHIF) with the National Health Insurance Fund (NHIF) with its its
28 regional offices28 regional offices• the voluntary health insurance fundsthe voluntary health insurance funds
EAMA – EAMA – MissionMission
CContinuous improvement of health care quality ontinuous improvement of health care quality and safety. and safety.
CConstant control and monitoring of health care onstant control and monitoring of health care providers’ activitiesproviders’ activities and also of the activities of and also of the activities of
compulsory and voluntary health insurance funds compulsory and voluntary health insurance funds and motivates them to continuous improvement of and motivates them to continuous improvement of
their professionalismtheir professionalism
EAMA – EAMA – VisionVision
TTo stimulate changes in health care in order to o stimulate changes in health care in order to guarantee accessguarantee access of BG’s citizens to health care of BG’s citizens to health care services of good quality, safety, efficiency and services of good quality, safety, efficiency and
effectivenesseffectiveness
EAMA – EAMA – ValuesValues
OurOur ValuesValues
II nnovationsnnovations
AA rrangement rrangement
MM oral oral
OO tgovornost (responsibility) tgovornost (responsibility)
EAMA – EAMA – Strategic GoalsStrategic Goals
• To develop a system for total quality management at a national To develop a system for total quality management at a national
level;level;
• To initiate the legislation for quality management;To initiate the legislation for quality management;
• To avoid the dissemination of corrupt health care practices;To avoid the dissemination of corrupt health care practices;
• To develop data base in the field of health care quality;To develop data base in the field of health care quality;
• To develop medical errors’ reporting system;To develop medical errors’ reporting system;
• To motivate all health care partners to work for quality improvement To motivate all health care partners to work for quality improvement
of health care services, etc.of health care services, etc.
EAMA – EAMA – StaffStaff
• The nThe number of people working in the organisation – 68 umber of people working in the organisation – 68
• 4 Specialized and 1 Administrative Directorates4 Specialized and 1 Administrative Directorates
• No regional officesNo regional offices
EAMAEAMA
Executive Director
Deputy Director Chief Secretary
Administrative Directorate
Quality Assurance Directorate
Insurance & Patients Rights
Directorate
Medical audit of HC
establishments Directorate
Medical audit of hospitals
Medical audit of out-patient
care
Insurance Rights
Patients Rights
Financing & IT
Administration & Legislation
EAMA – EAMA – Three stages in the Three stages in the development of the EAMAdevelopment of the EAMA
Ist stage: 2010 – 2013 Ist stage: 2010 – 2013
•Q & PS issue; Q Strategy 2010-15; Q analysesQ & PS issue; Q Strategy 2010-15; Q analyses•Patients RightsPatients Rights•Register of medical errors based on people’s complaintsRegister of medical errors based on people’s complaints•Training of staffTraining of staff•Collaboration w/ other HC partnersCollaboration w/ other HC partners•Open to the public Open to the public
EAMA – EAMA – Three stages in the Three stages in the development of the EAMAdevelopment of the EAMA
• Administrative structure to the MoHAdministrative structure to the MoH• No Q & PS issueNo Q & PS issue• No Q analysesNo Q analyses• No collaboration w/ other HC partnersNo collaboration w/ other HC partners• Limited staff trainingLimited staff training • Limited openness to the publicLimited openness to the public
IInd stage: 2013 – 2015 IInd stage: 2013 – 2015
EAMA – EAMA – Three stages in the Three stages in the development of the EAMAdevelopment of the EAMA
• Q & PS issue; up-date Q Strategy; Q analyses; Q Q & PS issue; up-date Q Strategy; Q analyses; Q indicatorsindicators
• Patients RightsPatients Rights• Medical Errors Reporting System at national level w/ Medical Errors Reporting System at national level w/
UBGPsUBGPs• Training of staff & HC professionalsTraining of staff & HC professionals• Collaboration w/ other HC partners Collaboration w/ other HC partners
IIId stage: 2015 – IIId stage: 2015 –
EAMA – EAMA – Three stages in the Three stages in the development of the EAMAdevelopment of the EAMA
2010 – 20132010 – 2013 2013 – 2015 2015 –
Q & PS issue; Q Q & PS issue; Q Strategy 2010-15; Q Strategy 2010-15; Q analysesanalyses
+(Q indicators)
Patients RightsPatients Rights + +
Register of medical Register of medical errors based on errors based on people’s complaintspeople’s complaints
+
Training of staffTraining of staff +(Limited)
+(& HC professionals& HC professionals)
Collaboration w/ other Collaboration w/ other HC partnersHC partners
+
Open to the public Open to the public +(Limited)
+
EAMA – EAMA – Collaboration with HC Collaboration with HC PartnersPartners
The EAMA works with the following institutions and The EAMA works with the following institutions and partners:partners:
• Ministry of Health;Ministry of Health;• Regional Health Authorities – 28;Regional Health Authorities – 28;• NHIFNHIF / RHIFs/ RHIFs;;• Executive Transplantation Agency;Executive Transplantation Agency;• Scientific Societies of Medical Professionals;Scientific Societies of Medical Professionals;• Union of BG Physicians / of BG Dentists;Union of BG Physicians / of BG Dentists;• Prosecutor’s Office of Bulgaria;Prosecutor’s Office of Bulgaria;• National Ombudsman;National Ombudsman;• Ministry of Justice;Ministry of Justice;• National Social Security Institute;National Social Security Institute;• Patients’ Organizations.Patients’ Organizations.
EAMA – EAMA – Q & PSQ & PS
The Role of the EAMA for Q & PS monitoringThe Role of the EAMA for Q & PS monitoring •Developed checklists and inspects the performance of the Developed checklists and inspects the performance of the health care establishments to assess the compliance to the health care establishments to assess the compliance to the requirements of the medical standardsrequirements of the medical standards and Health Care and Health Care Act; Act; •Periodically develops Q analyses related to a specific Periodically develops Q analyses related to a specific issue (i.e. AG, children, etc.) with recommendations for issue (i.e. AG, children, etc.) with recommendations for improvement;improvement;•Works with Works with the Scientific Societies of Medical the Scientific Societies of Medical Professionals to implement improvement activities in their Professionals to implement improvement activities in their domains.domains.
EAMA – EAMA – Q & PSQ & PS
The Role of the EAMA for Q & PS monitoringThe Role of the EAMA for Q & PS monitoring
Future activities:Future activities:•To work on development of Medical Errors Reporting To work on development of Medical Errors Reporting System at national level together with the Union of the BG System at national level together with the Union of the BG Physicians;Physicians;•To work on development of List of Q & PS Indicators;To work on development of List of Q & PS Indicators;•To work on methodology for hospital ranking;To work on methodology for hospital ranking;•To organize training and train HC professionals towards Q To organize training and train HC professionals towards Q & PS& PS
EAMA – EAMA – Organizational good Organizational good practicespractices
Organisational good practices:Organisational good practices:
• Legislative initiatives for changes of the legislation Legislative initiatives for changes of the legislation towards Q & PS;towards Q & PS;
• Very good collaboration with other HC partners;Very good collaboration with other HC partners;• Q improvement initiatives together with the Q improvement initiatives together with the Scientific Scientific
Societies of Medical Professionals;Societies of Medical Professionals;• Openness to the public and media;Openness to the public and media;• Questionnaire on the website for assessment of our Questionnaire on the website for assessment of our
clients’ satisfactionclients’ satisfactionCons:Cons:• One centralized structure at national level w/o One centralized structure at national level w/o
regional officesregional offices
EAMA – EAMA – Openness to the public and Openness to the public and mediamedia
• Publications of Q analyses and annual reports Publications of Q analyses and annual reports on the website: on the website: www.eama.bg;;
• Proactive to the mediaProactive to the media – – flyers, explicative flyers, explicative campaigns, press conferencescampaigns, press conferences;;
• Visiting hours to meet inspectors – every Visiting hours to meet inspectors – every Thursday from 1 pm to 4 pm;Thursday from 1 pm to 4 pm;
• Questionnaire on the website for assessment Questionnaire on the website for assessment of our clients’ satisfactionof our clients’ satisfaction
EAMA – EAMA – Pros and Cons of the Pros and Cons of the organizational solutionsorganizational solutions
ProsPros
•Put the Q & PS issue at the Put the Q & PS issue at the national level; national level; •Involves HC partners in Q & PS Involves HC partners in Q & PS initiatives;initiatives;•Increases the awareness of the Increases the awareness of the public and media towards Q & PS; public and media towards Q & PS; •Legislative initiativesLegislative initiatives;;•Increased trust Increased trust
Cons Cons
•Increased number of complaintsIncreased number of complaints•Increased workload of the Increased workload of the inspectors inspectors •No increase of the human and No increase of the human and financial resourcesfinancial resources
EAMA – EAMA – ConclusionConclusion
The most important result from the EAMA’s activities is The most important result from the EAMA’s activities is that fear and mistrust of the health care professionals that fear and mistrust of the health care professionals
from that institution were replaced by gratitude and from that institution were replaced by gratitude and appreciation because the aim of the EAMA is not appreciation because the aim of the EAMA is not
punishment but to guarantee access to health care of punishment but to guarantee access to health care of good quality and safety, protection of patients’ rights and good quality and safety, protection of patients’ rights and
dissemination of good practices.dissemination of good practices.
