Health Systems Improvement Across the Globe

Success Stories from 60 Countries

Jeffrey Braithwaite, Russell Mannion, Yukihiro Matsuyama, Paul Shekelle, Stuart Whittaker, Samir Al-Adawi, Jeffrey Braithwaite, Russell Mannion, Yukihiro Matsuyama, Paul Shekelle, Stuart Whittaker, Samir Al-Adawi

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9780367881740
• eBook ISBN: 9781317123279
• Edition: 1
• Topic: Technology & Engineering
• Subtopic: Service Industry
• Index: Technology & Engineering

Following on from 2015's Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries, this book encompasses a global perspective on healthcare while shifting the focus from reform to showcasing success stories of healthcare systems worldwide. It provides explanations of why various facets of healthcare systems work well in different contexts and offers the reader alternative models for consideration. The book features contributions from 60 countries, going much further than the common practice of focusing on affluent Western nations, to provide a comprehensive exploration of the success of healthcare systems globally. The majority of literature on health-sector improvement attempts to address the problems within systems, relating the errors that can and do occur, for example, and offering solutions and preventative strategies. This book of country case studies will approach the enhancement of health systems, patient safety and the quality of care in a new and innovative way, comprehensively surveying and synthesizing the success stories of healthcare systems around the world, utilizing Hollnagel's Safety-II approach to acknowledge the importance of exploring what goes right, what works well, and why it works. These success stories may include reference to macro, meso or micro levels of healthcare systems, various sectors (e.g., aged care, acute care or primary care), or specific programs or projects. Health System Improvement Across the Globe: Success Stories from 60 Countries is unprecedented in terms of both reach and positive emphasis, and as such will be instrumental in changing ways of thinking about and guiding health-sector improvement.

Part I

The Americas

Paul Shekelle

In this first section of the book, we traverse the Americas, a vast landmass ranging from the very northern reaches of Canada, the United States of America, and Greenland, abutting the Arctic, just 700 kilometers from the North Pole, to three desolate islands off the tip of Argentina known as Southern Thule, often considered part of Antarctica. The Americas cover 8% of Earth’ s total surface area and 28.4% of its land area.

These nine case studies from the Americas are remarkable most for their diversity. The countries we have enrolled reflect this diversity, in size, population, geography, and climate. They span the artic climate in Canada, through the equatorial climate of Guyana and Ecuador, to the Southern Hemisphere climate of Argentina and Chile. They are diverse, too, in how their healthcare systems are organized and financed.

The healthcare success stories being addressed vary greatly: stroke care (Canada), surgical safety (the United States of America), primary care (Venezuela), geriatrics (Guyana), hospital quality and safety (Brazil, Chile, and Ecuador), healthcare access (Mexico), and a number of conditions (Argentina). The funding sources for the initiatives also vary: government-funded initiatives are described in the chapters from Venezuela, Mexico, and Argentina; non-governmental organizations, foundations, and charitable society-funded initiatives are described in the chapters from Guyana, Brazil, Canada, and Argentina; and a professional society-funded initiative is described in the chapter from the United States of America.

The interventions or programs themselves are also extremely diverse. Enrique Ruelas and Octavio Gó mez-Danté s describe a Mexican government-funded program to increase access to care; Marcos Iturriaga and Leonel Valdivia in Chile, and Amy Showen and Melinda Maggard-Gibbons in the United States of America, describe performance management systems and their effect on hospital quality and safety; Claudia Travassos, Victor Grabois, and José Noronha describe an Internet-based intervention in Brazil to disseminate safety interventions; Jonathan Mitchell, Qendresa Hasanaj, Hé lè ne Sabourin, Danielle Dorschner, Stephanie Carpenter, Toby Yan, Wendy Nicklin, G. Ross Baker, John Van Aerde, and Sarah Boucaud describe the effect a non-governmental accrediting body had on stroke care in Canada; Joná s Gonseth and Maria Cecilia Acuñ a describe one hospital’ s transformation from worst to first in response to a new governmental governing process in Ecuador; William Adu-Krow, Vishwa Mahadeo, Vasha Bachan, and Melissa Ramdeem describe a successful attempt to bring multiple services to geriatric patients in rural Guyana; Pedro Delgado and Luis Azpurua describe an attempt to increase access to primary care for underserved populations; while Hugo Arce, Ezequiel García-Elorrio, and Viviana Rodrí guez catalog a number of initiatives in Argentina. A theme in many of the chapters is the vital need for strong leadership and adequate resources in order to be successful. How success is accomplished in different settings is a key learning point.

1

Argentina

Successful Initiatives in Quality and Patient Safety in Argentina

Hugo Arce, Ezequiel García-Elorrio, and Viviana Rodrí guez

CONTENTS

Background

Description of Selected Government Activities that Proved to be Successful in the Field of Quality of Care

External Quality and Patient Safety Evaluation Initiatives

Training Initiatives on Quality and Patient Safety

Health Technology Assessment

Background

The Argentine Republic, as defined by its constitution, has a federal structure, whereby the provinces are independent from the federal government regarding health and education. Public health services (hospitals, outpatient centers) and prevention programs are administered by provincial authorities, while the National Health Ministry establishes priorities and general policies, funds strategic programs, and exercises the administration of the health system. Argentina’ s healthcare system is a mixed system consisting of public, private, and social security subsectors.

A number of healthcare government initiatives and a great many non-government projects are currently being developed and implemented. Among these is the Categorizing Authorization Program (CAP), which aims to unify standards for the licensing of public and private services across the country while developing the operational and technological capacity of healthcare services. The CAP is also tasked with the development of government-sponsored supplementary coverage for at-risk populations, the development of practice guidelines for prevalent diseases, and the assessment of healthcare technologies in order to rationalize investments and determine quality requirements.

There are also a number of non-governmental organizations currently in development: three accreditation bodies and two International Organization for Standardization (ISO) certification boards; two institutes specializing in teaching and research; four specialized scientific societies; two quality awards; and at least seven university training programs in quality and safety.

Despite the wide availability of public services, which represent 55% of installed capacity in inpatient beds, the private sector, as provider of social security and health insurance plans, is the most dynamic sector of the health system.

While quality of care and patient safety has not been the central focus of Argentinian health policy, successive administrations, regardless of political affiliation, have managed to implement a number of government and non-government health system initiatives, with varying degrees of success.

Description of Selected Government Activities that Proved to be Successful in the Field of Quality of Care

One of the Argentinian system’ s most enduring challenges has been convincing the individual provinces’ legislative regimes to authorize the operation of new private assistance services (Arce, 1998). Inconsistencies in the response capacity and technological capability of Argentinian institutions have exacerbated this problem. To resolve this problem, the CAP was developed through the Federal Health Plan (2003– 2007) and approved by the Federal Health Council (CoFeSa^*) (Arce, 1999). The CAP was developed to unify the different licensing rules, for both public and private services, and to set the response capacity for each institution. This program is currently administered by provincial ministries.

In 1983, the National Health Ministry established the National Program of Epidemiology and Hospital Infection Control to address the problem of healthcare-associated infections (HAIs) in Argentina. Following an initiative of the Argentine Society of Infectious Diseases (SADI) in the late 1990s, the government mandated the registration and classification of HAIs in public and private hospitals through the National Program of Hospital Infections Surveillance in Argentina (VIHDA). The VIHDA program, which received support through external financing, is part of the development of the National Program of Epidemiology and Hospital Infection Control. Its objective is the monitoring of HAIs in healthcare public organizations. The program manages incidence surveillance and conducts an annual prevalence study in which both public and private healthcare organizations participate.

Similarly, in 1993, the National Health Ministry, with the cooperation of several scientific societies, created the National Program of Quality Assurance of Healthcare (PNGCAM). This program developed multiple clinical practice protocols for diagnostic procedures and guidelines aimed at reducing treatment variability.

In 2005, after a severe economic and institutional crisis, the government implemented a program of subsidies for maternal and child care, called the NACER Plan. This plan secured coverage of pregnancy, childbirth, postpartum care, and pediatric care up to 5 years of age. Under the NACER Plan, which involved over 7000 healthcare facilities, more than 4.7 million pregnant women and children received coverage, and 37 million preventive interventions were undertaken. The plan’ s provisions include access to care during pregnancy and the postnatal period, and for children under 6 years old.

The good results of the NACER Plan led to the development and implementation of the SUMAR Plan, which extended coverage into adolescence up until the age of 18, and until 64 years of age for the female population. One of the objectives of the SUMAR plan is to improve quality of primary care. A pay-for-performance strategy has been used in order to accomplish this objective. The program involves important collaboration between social security and the private and public health sectors. This plan is financed by the World Bank as well as the national government and the provinces. Outcomes are not available at the time of writing.

External Quality and Patient Safety Evaluation Initiatives

In 1994, the group that drafted the Accreditation Manual for Hospitals in Latin America and the Caribbean established the Technical Institute for the Accreditation of Healthcare Organizations (ITAES), which develops accreditation programs for inpatient healthcare organizations, chronic dialysis centers, ...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Copyright
• Contents
• Preface
• Acknowledgments
• About the Editors
• About the Contributors
• Contributors
• Introduction
• Part I The Americas
• Part II Africa
• Part III Europe
• Part IV Eastern Mediterranean
• Part V South-East Asia and the Western Pacific
• Discussion and Conclusion
• References
• Index