[Quality control activities in 62 hospitals of the National Health System]. / Actividades de garantía de calidad en 62 hospitales del Sistema Nacional de Salud en España.

BACKGROUND: The increasing interest for quality in hospital care brought the need to evaluate the effect of quality control and quality assurance strategies that are being or could be implemented in spanish hospitals. METHODS: This article describes the results of the pre-assessment phase of a study carried out as a european concerted action in a total of 262 hospitals in 15 european countries. Spain contributed with 88 hospitals divided in two groups of 62 and 16 hospitals. The study herein reported refers to the group of 62 hospitals belonging to the spanish National Health System in which the characteristics of the hospital and the baseline situation in respect to quality assurance structures and activities have been assessed through the answers to the standard questionnaire used the study. RESULTS: Sixty-two hospitals filled out the preassessment questionnaire. Twenty three (37%) have a quality assurance programme and eighteen have personnel assigned to it. Clinical or quality control committees exist in 56 hospitals (90.3%). Fifty six hospitals (88.7%) know their autopsy rate, and 27 (43.5%) know their nosocomial infection rate as well as the adverse reactions due to blood transfusions. Complaints are registered in 56 hospitals (90.3%) and patients surveys are carried out in 54 (87.1%). Only 33 hospitals (53.2%) actually use this data for quality assurance purposes. CONCLUSIONS: Most of the quality activities in hospitals are carried out by physicians or nurses in the different clinical committees considered as quality committees. The patients surveys results and the data from patients complains are not used in those committees as inputs for quality actions. The committement of the top hospital management is needed to achieve an integrated approach to quality activities in hospitals.

[The continuous improvement of the health system: results of the phase 1 of the implantation of the Quality Plan in Spain (1986-1992)]. / La mejora continua en el Sistema Sanitario: Resultados de la 1a. fase de implantación del Plan de Calidad en España (1986-1992).

The increasing society demands for improved quality in health care are forcing the health care systems to evaluate their organizational performance. Quality activities were initially limited to inspection and final product control, whereas now they are implemented throughout the whole organisation as Total Quality Management. This approach applies specific methodologies which require valid and reliable daily activity data from everyone in the organisation units. A Total Quality Plan for the spanish health care system was set in motion in 1986. From 1986 to 1992 the First Phase of the Plan was carried out: firstly, an appropriate information system was established in order to generate and exploit valid data about activity and cost; secondly a cultural change towards Continuous Quality Improvement was initiated throughout training and implementation of methodologies and tools of Total Quality Management in the National Health Care system institutions. The implementation of a Continuous Improvement general policy as a second phase, requires the explicit commitment of the Health System top management.