One of the public institutions under the Ministry of Health and Welfare, HIRA, is working to try to make the more safe clinical environment through the various quality management activities. I'd like to suggest my opinion on the way how the developing countries can establish road-map when they start the quality control of medical care in the national level.

 

The road-map can be implemented in the following stage:  (Beginning) Disease-based evaluation: 1) Whether complication occure or whether necessary treatment is performed 2) In the case of countries with an information infrastructure that can check the treatment time from the time entering the emergency room, it is possible to check Whether the specific treatment was done within the golden time (For example, Intravenous t-PA rate within 60 miniutes for Acute Ischemic Stroke) 3) If the longitudinal evaluation is possible with the variable ‘time’ of each patient’s medical record in the country, It is possible to check ‘readmission rate(revisit rate to the emergency room) within 30 days after discharge’ .  (Middle) Policy-oriented evaluation: During the disease-based evaluation implements, healthcare data, healthcare personnel, and evaluation organization for quality assessments might be well established. And then government could consider introducing country’s key health issue as items. As one of the Korea examples, as becoming aging society, the number of dementia patients increases, and a lot of related-medical resources are required for the management of them. Therefore dementia is being considered as the assessment items.  (End) Comprehensive(Institutional) evaluation: ultimately, patient-centered, integrated hospital unit quality management is needed. However, comprehensive hospital unit quality management is usually considered to be more difficult stage in terms of methodologies and reaching agreements with providers. As a long-term goal, not a short-term goal, the government needs to continuously learn from the success stories of other countries

 

It can be difficult to establish well made assessment system at the national level in a short period of time and induce behavioral change of providers. So I think it is an essential thing to learn from each other’s success stories.