the network and in association with other health- and quality- advanced the more .... Noel Harrington the re-energizing of a European Clearing House on Health.
International Journal for Quality in Health Care 2001; Volume 13, Number 1: pp. 1–3
Editorial
European Society for Quality in Healthcare: the experience of learning to work together in Europe Europe, while far from being the biggest continent, may certainly be called the most diverse, with its myriad countries, languages and cultures. And history in Europe, somehow seems never that long ago . . . For any profession the task of coming together in Europe may seem a daunting one; equally so for health professionals. But the goal of improving quality in health care can only be advanced the more we share our findings, our problems, and our often scarce resources. Working together in Europe is going to become a lot more common, particularly with the European Union (EU) becoming increasingly involved in health care. And as part of all this, lies the European Society for Quality in Healthcare (ESQH). The European Society for Quality in Healthcare was begun in 1998 [1]. It developed from a number of strands in the health care world at the time. Some people at the International Society for Quality in Healthcare (ISQua) were looking for more effective ways of networking within regions. European research projects under the aegis of the EU such as the Biomed programmes [2–4] were launched with the aims of harmonizing and co-ordinating research, encouraging collaboration between teams of interested researchers. The projects enabled researchers to bring together their accumulated expertise in a research network to find solutions to those health problems which are common to the European member states but which are more likely to be solved by European collaboration. These initiatives had given researchers a taste for and an appreciation of what could be achieved through multinational co-operation. Linking national societies that already existed in Europe and within ISQua seemed to be the logical next step. A group of presidents and former presidents of national societies came together meeting first in London and then in Dublin. A consultative process followed each meeting between those presidents and their respective national councils. And at the ISQua Conference in Budapest 2 years ago the European Society for Quality in Healthcare was officially launched. What can we say about ESQH and how has it done during these 2 years? In the story of ESQH, young as it still is, hopefully there are lessons for all of us in learning to work together in Europe. And perhaps there is also a more general
lesson in what it is like to try to create a regional society with people from different cultures, with different languages and sometimes with very different ways of doing things. Firstly, what is ESQH? It is a network of national societies dedicated to the improvement of quality in health care at national and international levels. It is committed to the achievement of its aims through collaborative action within the network and in association with other health- and qualityrelated organizations in Europe. It is a platform where the most local of expertise can receive Europe-wide attention, advice and support. It is our belief that ESQH’s added value should be sought in networking, in the sharing of information and expertise of members, and in linking with other professional organizations. In our constitution, ESQH has three stated aims: to support quality improvement in European health care by creating a formal European network of national societies; to strengthen the integration of European national societies’ knowledge and experience; and to provide a contact point and an influential agency with other health-related organizations, but also to be a network of individuals for individuals. At present the 15 national societies that are members of ESQH are: Belgium, Denmark, Germany, Greece, Finland, Hungary, Italy, Ireland, Norway, Poland, Spain, Sweden, Switzerland, the Netherlands and the UK. It was no easy task to bring all these societies together. Some groups prefer to remain independent and are naturally cautious about a possible loss of that independence. Perhaps some felt that, being already members of ISQua, this new society would only mean another level of bureaucracy or even hierarchy. So very quickly the principle of equality was established. The ESQH Board works like this: one national society means one representative, which means one vote. But when a society has a board, the members of that board have to meet. So the very fact that ESQH brings together such geographic and cultural diversity results in its own problems. How can members from countries like Norway and Sweden in the north and Italy and Greece in the south regularly get together and discuss ideas? So we came up with the following schedule: a teleconference at least once a month and two workshops a year. The idea behind the workshops was that at each one a specific theme could be
This editorial is based on a workshop presentation given by Dr. Lorenzo at the 17th International Conference of The International Society for Quality in Health Care, Dublin, Ireland, 16 September 2000.
2001 International Society for Quality in Health Care and Oxford University Press
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Editorial: S. Lorenzo
developed presenting a European perspective on some area of quality improvement and drawing on the expertise and experience of individual members or national societies. The workshops are important opportunities for our members; they are a place to meet, to share, and to learn. The first workshop was held in Solothurn, Switzerland in 1999. The focus was the exchange of knowledge in relation to information, training, implementation and review activities. It was also a chance for ESQH to meet formally such organizations as the European Organization for Quality (EOQ) [5], the European Foundation for Quality Management (EFQM) [6], the Hospital Program for Europe (HOPE) [7] and the European Quality Nursing Network (EuroQuan) [8]. The Solothurn workshop also proved vital in the development of our Society, because it was at this board meeting that various tasks were assigned to the board members in groups of two. This system of task delegation reflects ESQH’s principle of shared ownership. It is also an attempt to ensure equal participation and to reinforce the democratic principle that with benefits comes responsibility. Participation is of course, a vital consideration for any group thinking of setting up a society. Will people do what they say they will do? Who will apply a little pressure when needed? And can the decision be made to reduce the number of observers on the Board and convert them to ‘do-ers’? These are tough questions. People have their priorities, politics always creeps in, good ideas can turn out to be impractical, personalities may clash. But these are also questions that need to be addressed if a regional society is to succeed. In this way we allow each individual to concentrate on an area in which he or she specializes. The best way to ensure that a task is completed and completed well is to allow individuals to do a job they will enjoy and one that matches their expertise. This is a luxury ESQH can afford as a result of the diversity of its Board. But it is a universal principle that if you give someone a job they hate, you can not expect perfection. The second workshop was held in Sicily. The theme was ‘Developing Quality Healthcare Organisations in Europe through Learning, Education and Training’. The workshop explored and clarified the role of learning, education and training in relation to quality in effecting significant change in health care organizations in Europe. The third workshop was held in Utrecht, the Netherlands in March 2000. The theme was ‘The State of the Union: Linking Policy and Actions on Healthcare Quality between the EU and Member States’. The workshop had three stated objectives: to identify quality implications of European health policies, to identify and compare national quality policies, recognizing possible deficiencies and initiating appropriate actions, and thirdly to consider advances in developing European actions on quality improvement. Besides the content of the papers delivered, Utrecht was a good opportunity for ESQH to meet representatives of the European Commission and from the government health departments of various European countries. It is extremely important for any society to make these kinds of contacts and, once made, to develop them. No society can exist by itself: networking is crucial.
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Networking is not as Machiavellian as it might sound, because by its very nature it is a process of give and take. Earlier we mentioned that we communicate by means of monthly teleconferences. These are both a necessary and useful way of keeping in touch, of sharing ideas and, of course, of discussing problems. Sometimes it is just nice to talk to people and hearing a friendly voice can really help you to re-energize. E-mailing is great, but a society that doesn’t speak would be a very cold place and it is hard to remain committed to something for which you have no feeling. It seems almost too obvious to ask, but who would remain a member of a society that has lost all its enjoyment? Yes, we are all health care professionals, but we are also humans, and what would be the point of going to places like Utrecht and Dublin if we weren’t going to have a little fun? But teleconferences, workshops and all our other activities, even the fun ones, require organization and voluntary organization can only get you so far. People have full-time jobs and limited budgets. They have bosses to keep happy and family and social lives. All the goodwill in the world does not create more than 24 hours in one day, or 7 days in one week. And so it quickly became apparent that ESQH needed a dedicated secretariat and funding. Our President, Stiofan deBurca, set up the Secretariat in Limerick, Ireland with the help and time of a number of colleagues. A system of internal communication was developed that allowed us all to keep in touch. We all have email addresses (and some of us even read our mail!). Seriously though, e-mail is the best means for daily communication. It is good for asking a simple question and it is good for sending big PowerPoint presentations. It allows one Board member to write to another individually or to all the members at the same time. The next phase of this written communication will be when we launch our ‘chat-room’ forum on our website www.esqh.net. This will be a most welcome development, when any number of people will be able to join in a discussion and receive immediate answers to their questions. A society can only be as successful as its individual members want it to be. We are all busy people, all of us official representatives of our societies. And so for ESQH to work we all really need to be sure of our commitment, to know for ourselves how much we can give. And if it turns out that we do not have time to match our commitment, then there is the hard decision of whether it would be better to pass on that commitment to somebody else. Perhaps the first phase of ESQH will turn out to be the coming together of all these societies through their respective representatives. And perhaps the next phase will be the inclusion of not just a representative of each society but of what each society represents. In this way ESQH can be a sum of all its parts; a European society of which every individual interested in quality, whether he or she lives in Scotland or Sicily, Granada or Gdansk, can be a member. ESQH can be a society where every individual in Europe can contact the secretariat either to offer or to receive an idea. This is the potential of ESQH and it is what all the Board Members are striving to achieve. And what of our specific plans? Following our Spring
Editorial: S. Lorenzo
Workshop in Utrecht the Dutch Government has expressed interest in the potential of ESQH and has matched that interest with a promise of funding. This funding will be specifically earmarked for ESQH projects that develop the use of information technology. The first major project within this plan is due to be the re-energizing of a European Clearing House on Health Outcomes and Evidence-Based Medicine. It is a project undertaken jointly by the Irish and UK members of ESQH and by other interested individuals. Many countries have at times set up their own such clearing houses. One or two, including Ireland’s, are still active. Others, often through a lack of funding rather than interest, have fallen through. With the support of ESQH, with the work of the individuals concerned, and now with funding, this project may really go on to demonstrate what ESQH can achieve, with benefits that reach far beyond our individual members. Also, and at an earlier stage of development, is a project comparing the different adaptations of the EFQM Excellence model. In addition, we are proposing a study of previous quality initiatives that have failed. We will try to identify the common factors in these failures and will attempt to remove these factors from future initiatives. The cost-saving benefits of such a study could be quite significant. In addition, there is our comparative study of award systems and an in-depth look at quality training across Europe. ESQH is working on a very broad range of interests but we believe this is one of the great strengths of our Society. We can reach across the continent to all its individuals, to the talent that exists on this continent, the levels of expertise, the years of experience and the history of innovation. Added to this is the desire to improve the lives of all our citizens and concern for them at an individual level, at a political level. This is what ESQH believes it can tap into, because we are the European Society for Quality in Healthcare.
Susana Lorenzo Fundacio´n Hospital Alcorco´n, Alcorco´n (Madrid), Spain Spanish Society for Quality in Health Care European Society for Quality in Health Care Noel Harrington European Society for Quality in Health Care
References 1. deBurca S, Shaw C. European Societies for Quality in Healthcare. Int J Qual Health Care 1999; 11: 263–265. 2. Liberati A, Apolone G, Lang T, Lorenzo S. A European project assessing the appropriateness of hospital utilization: background, objectives and preliminary results. Int J Qual Health Care 1995; 7: 187–199. 3. Shaw C. External quality mechanisms for health care: summary of the ExPeRT project on visitatie, accreditation, EFQM and ISO assessment in European Union countries. Int J Qual Health Care 2000; 12: 169–175. 4. External Peer Review Techniques Project, ExPeRT, CASPE Research, London, UK. http://www.expert-caspe.demon.co.uk 5. European Organization http://www.eoq.org
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6. European Foundation for Quality Management, Brussels, Belgium. http://www.efqm.org 7. Hospital Program for Europe, http://www.aries.eu.int/hope/
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8. European Quality Nursing Network, EuroQuan, London, UK. http://www.fons.org/networks/eq/euroquan.htm
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