Transcript Jozef RADIMECKY

Implementation of quality
standards into practice:
Czech Republic
Josef Radimecky
European conference - Building and EU consensus for minimum quality standards in DDR
Plenary session III: Translating standards into practice
15-17 June 2011, Brussels
Content
 ‘Heritage’ of communism
 Implications for drug services and standards of quality
 Standards of professional eligibility
 Czech vs. EQUS
 Certification of services – basic terms
 Main goals of drug services certifications
 Basic principles of certification
 Key players of certification process
 Process of certification
Evaluation of certification process - lessons learned
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‘Heritage’ of communism
1948 - 1989
 communisms - ‘ideal classless’
society’ – no social problems…
 drug use - depraved ‘capitalist
style of life’ – tabooed
 drug users - public enemies of
the society – persecuted
 everything under control of the
state – no NGOs
‘Spirits lead back to capitalism,
and not forward
towards socialism.’ V. I. Lenin
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Czech Standards and Certification
 Czech society - little knowledge
about drugs and responses
 lack of experts
 lack of prevention & treatment
services, no HR
 compulsory treatment of drug
addicts exclusively by psychiatrists
 inappropriate legislation – drug
policy and services, NGOs (1989)
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Implications for services and standards
Year
Activity
1993
National Drug Commission and Launch of the Czech Drug
Policy – aiming to establish missing types of services
1995
Minimal Standards for Drug Services (DDR, HR) – initiative of
NGOs
1999
Preparation of Standards for Drug Services Certification – WGs
for individual types of services
2001-02 Phare Twinning with Austria – Task Force Certification
2003
Approval of Certification System, 1st trainings of certificators
2005
Launch of Certification of Drug Services, 2nd training of
certificators, Approval of standards for drug prevention
2007
Evaluation of the System of Drug Services Certification after 2
years, Launch of Certification of Drug Prevention Services
2011
Revision of standards and process of certification
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Standards of professional eligibility
General part (all types of services)
Special part (acc. type of services)
Accessibility of professional services
Detoxification
Patients/clients rights
Out-reach programmes
Admission and initial assessment
Low-threshold centres
Spectrum and principles of provided services
Out-patient treatment
Human resources management
Stationary programmes
Management and education of staff
Short- and mid-term rezidential treatment
Availability and external relations
Organization of services
Rezidential care in therap. communities
Financial management
After-care programmes
Service environment
Substitution treatment
Minimal safety
Evaluation of quality and efficiency of services
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2007 Drug prevention services
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Czech vs. EQUS
Level 1:
interventions
Level 2: services
Level 3: systems
& policies
Structural quality

Type of setting
needed for
implementation

Resource
standards

Legal & ethical
adequacy
standards
Process quality

Implementation
standards

Procedural
standards

Standards for
networking
&
cooperation
among services
Outcome quality

Effectiveness
standards

Effectiveness
standards

Coverage
standards
Benchmarks

Cost-benefit
ratio

Cost-utilization
ratio

Costeffectiveness
ratio
Outcome quality and Benchmarks – not assessed within assessment of services
quality (other instruments), no clear standards set up,
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Certification of services – basic terms
 Drug services – interdisciplinary complex of health,
social and/or educational interventions provided to
drug users and/or their close persons.
 Certification of professional eligibility – examination
and formal recognition – drug services provided in
line with good practice (criteria of quality and
complexity).
 Process of examination of drug services by external
peer evaluators with the use of shared and officially
approved standards.
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Main goals of drug services certifications
to contribute to:
 an improvement of quality of drug services in
benefit of their clients (+) ;
 an integration of drug services into the system of
health and social services in order to minimise
risks of marginalization of their clients (-);
 a fulfilment of state responsibility in quality
assurance of services provided and funded from
public sources (+);
 an efficient funding from public sources (+/-).
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Basic principles of certification
voluntariness – certification is not obligatory, services
providers ask for it and co-finance related costs – vs.
obligation only for NGOs – condition to receive funds from
public sources;
 transparency – process runs within predefined and by
National Drug Commission approved conditions;
 independency of examination – examination of services
organized by an independent NGO Certification Agency
and external peer evaluators;
 unity and inter-disciplinarity of criteria – shared and
approved inter-disciplinary standards used for examination
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Key players of certification process
Appeal against team of
examinators composition
Services
providers
&
their clients
Local
examination
Application for
certification
Certification
Agency
Secretariat of
NDC
Team of peer
examinators
Nomination of team members,
Report from examination –
findings and recommendation
with regard to certificate
Committee for
Certifications
Appeal against decision
of Committee for
Certifications
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Conclusions from examination
Decision about certification
National Drug
Commission
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Process of certification
Team elaborates more in depth
report from examination within 10
days with final recommendation
4
5
Assessment of service documentation prior on
the spot examination of service - 1-2 days –
team prepares protocol signed by both sides
Certification Agency –
nominates team and set up
a term of examination (in
30 days from submission)
3
Certification Agency receives
protocol and report from
exam. team and submitt it to
Committee for Certifiication
via Secretariat of NDC
Committee for Certifications
discusses proposals
submitted by Certif. Agency
6
Committee for Certifications:
• certificate for 3-4 years
• conditional certificate (e.g. for
1 year and consequent reexamination)
2
• no certificate
7
1
Within 30 days Committee for
Certifications informs provider
of service about final decision
Day of application
submission – start of
certification process
Provider of service applies by
Certification Agency for certificate
8
9
Certificate of professional
eligibility
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Drug services examination
 3 trained peer examinators – experienced (practitioner,
manager, civil servant – not in conflict of interests);
 1 – 2 days of examination – size of the service
 sources of examination:
 programme documents (sent to team in advance +
submitted on the spot),
 observation,
 interviews with manager, staff and clients (crosschecking written vs. reality);
 examination – „fresh eyes“, support, sharing of
experience, advice, recommendation for change
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Lessons learned
 evaluation of the process after 1st phase (2005-06);
 65 examinators/certificators trained and involved
 64 organizations providing 150 services certificated
 questionnaires – services providers + examinators:
 proces of examination (preparation, examination, conclusions)
 examinators (ethics, professional skills)
 organization and dissemination of information about the process
 pros and cons of participation in the process of certification
 proposals for change
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Main findings
Certification – contributed to an improvement of drug
services quality:
 „systematic elaboration of services provision step
by step…“
 „showed gaps we haven´t seen before…“
 „gave a feed-back to management of services –
what to do in order to assure quality of our
services…“
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Strenghts of certification
 documents clearly defining the whole process of
certification, roles of its participants – clear,
understandable and transparent
 coordination of the process by the Certification
Agency – communication with both examinators
as well as providers
 professional approach of
examinators/certificators
 continual learning by doing
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Weaknesses of certification
 some documents – room for improvement – i.e. how
to proceed in specific situations within examination
 General standards – some overlaps
 from examinators point of view – weakest part –
further education for examinators
 duplicity in drug services evaluation – National Drug
Commission standards vs. standards for social
services MoSA (5 out of 9 drug services)
 unequal opportunity – NGOs vs. state providers of
services not obliged to meet standards
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Thank you for your attention!
Contact:
Dr. Josef Radimecký, PhD., MSc.
Centre for Addictology
Psychiatric clinic, 1st Medical Faculty,
Charles University in Prague, CR
E-mail: [email protected]
www.addictology.org
Mobile: +420 724 240 778
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