Gezondheidspromotie
het begrip kwaliteit................................................................................................................10
Kwaliteitsdefinities ............................................................................................................10
Verschillende definitie van kwaliteit ...............................................................................10
❖ De mate van overeenkomst ................................................................................10
❖ De voortdurende inspanningen ...........................................................................10
❖ verantwoorde zorgverlening ................................................................................10
Algemene definitie .........................................................................................................10
Definitie IOM .................................................................................................................10
❖ 8 dimensies: de zorg moet ..................................................................................10
Invalshoek .....................................................................................................................11
❖ Professionele kwaliteit ........................................................................................11
❖ Patiënt/Cliëntgerichte kwaliteit ............................................................................11
❖ Beleidsgerichte kwaliteit......................................................................................11
❖ Sociaal gerichte kwaliteit.....................................................................................11
❖ Ideaalbeeldbenadering .......................................................................................11
Effectiviteit en efficiëntie ...................................................................................................12
Effectiviteit of doeltreffendheid:......................................................................................12
❖ Gebruiker: ...........................................................................................................12
❖ Professional: .......................................................................................................12
❖ Organisatie: ........................................................................................................12
❖ Methodiek: ..........................................................................................................12
❖ Overheid: ............................................................................................................12
❖ Samenleving: ......................................................................................................12
Efficiëntie of doelmatigheid: ...........................................................................................12
De relatie tussen kwaliteit en cultuur .................................................................................12
Normalisatie van afwijkingen .........................................................................................12
Verpleegkundige als verbeteraar ...................................................................................13
❖ Sleutelfiguur: .......................................................................................................13
❖ Valkuilen: ............................................................................................................13
Empowerment patiënt ...................................................................................................13
Kwaliteitszorg in België.........................................................................................................13
Wetmatige- en projectmatige initiatieven...........................................................................13
Kwaliteitsdecreet betreffende kwaliteit van gezondheids- en welzijnsvoorzieningen ......13
❖ Doel ....................................................................................................................13
❖ Krijtlijnen .............................................................................................................13
• Kwaliteitsmanagementsysteem .......................................................................14
, • Zelfevaluatie ....................................................................................................14
Patiëntveiligheid: Clinical Risk management .................................................................15
❖ Doel ....................................................................................................................15
❖ stimulerende organisatiecultuur ..........................................................................15
• betekenis.........................................................................................................15
• meten ..............................................................................................................15
❖ Veiligheid ............................................................................................................15
Een meer systeemgerichte benadering van incidenten ‘To err is human’ ......................16
❖ persoons- en de systeembenadering ..................................................................16
• De persoonsbenadering ..................................................................................16
• systeemgerichte benadering ...........................................................................16
Technologie en patiëntveiligheid ...................................................................................17
❖ Bijvoorbeeld de Elektronische alarmbelletjes ......................................................17
Accreditatie ...................................................................................................................17
❖ Wat is accreditatie? ............................................................................................17
• Accreditatie gaat na.........................................................................................17
❖ Voordelen van accreditatie .................................................................................17
• Intrinsieke factoren: .........................................................................................17
• Extrinsieke factoren – inspelen op: ..................................................................18
❖ Wat is het verschil met visitatie? .........................................................................18
Patiëntentevredenheid, klachtenbeleid en patiëntenrechten ..........................................18
❖ Patiëntentevredenheid ........................................................................................18
• Inzichten in het begrip patiëntentevredenheid .................................................18
• Mechanismen die aan de basis liggen van patiëntentevredenheid ..................19
❖ Klachtenbeleid ....................................................................................................20
• Definitie van een klacht ...................................................................................20
• Onderscheid tussen klager en klacht ...............................................................20
• Klachtenmanagement .....................................................................................21
❖ Patientenrechten.................................................................................................21
• Wettelijke bepalingen ......................................................................................21
• Krachtlijnen van de wet betreffende de rechten van de patiënt ........................21
Methoden en technieken kwaliteitsverbetering .....................................................................22
Visies op kwalitatieve verbetering volgens Berwick ...........................................................22
De theory of bad apples ................................................................................................22
De theory of continuous improvement ...........................................................................22
Basisstappen in modellen van kwaliteitsverbetering..........................................................22
de PDCA-cirkel. .............................................................................................................22
, ❖ Plan: ...................................................................................................................23
❖ Do (uitvoering): ...................................................................................................23
❖ Check (evaluatie): ...............................................................................................23
❖ Act (Opvolging en verankering): ..........................................................................23
❖ cyclische benadering ..........................................................................................23
Kwaliteitsverbetering en -toetsing .....................................................................................23
Stap 1: Doelstelling .......................................................................................................23
❖ S= Specifiek........................................................................................................23
❖ M= Meetbaar ......................................................................................................23
❖ A= Acceptabel ....................................................................................................23
❖ R= Resultaatgericht: ...........................................................................................23
❖ T= Tijdgebonden.................................................................................................23
Stap 2: Opstellen van een werkplan ..............................................................................24
Stap 3: Formuleren en vaststellen van criteria ...............................................................24
Stap 4: Meten van werkelijkheid en vergelijken met wenselijkheid (criterium) ................24
Stap 5: Aangeven van mogelijke oplossingen ...............................................................25
Stap 6: Plan van invoering .............................................................................................25
Stap 7: Toetsing achteraf en eventuele bijstelling ..........................................................25
Voorbeeld: Meten van kwaliteit, formuleren van criteria .................................................25
❖ Probleemstelling: ................................................................................................25
❖ Oorzaken: ...........................................................................................................25
❖ Criteria ................................................................................................................25
❖ Samengevat .......................................................................................................25
Kwaliteitstoetsing volgens Donabedian .............................................................................26
Criteria ..........................................................................................................................26
❖ Structuurcriteria ..................................................................................................26
❖ Procescriteria ......................................................................................................26
❖ Uitkomstcriteria ...................................................................................................26
Indicatoren ....................................................................................................................26
❖ Structuurindicatoren: ...........................................................................................26
❖ Procesindicatoren: ..............................................................................................26
❖ Uitkomstindicatoren: ...........................................................................................26
Kwaliteitsverbetering .........................................................................................................26
Probleemanalyse d.m.v. visgraatdiagram/ Pareto-analyse ............................................26
❖ Visgraat-diagram of oorzaak-gevolgdiagram (of Ishikawa-diagram) ....................27
❖ Pareto-analyse ...................................................................................................28
Technieken bij kwaliteitsverbetering ..............................................................................28
, ❖ Brainstorming .....................................................................................................28
❖ Enquête of vragenlijst .........................................................................................28
❖ Peer observation survey .....................................................................................29
❖ De suggestiebus .................................................................................................29
❖ Het klachtenbeleid ..............................................................................................29
❖ De WWWWHW-methode ....................................................................................29
❖ De kostenbaten analyse .....................................................................................29
Meten is weten .....................................................................................................................30
Wat is een meetinstrument ...............................................................................................30
Efficiëntie.......................................................................................................................30
Standaardisatie .............................................................................................................30
Normering .....................................................................................................................30
Objectiviteit....................................................................................................................30
Betrouwbaarheid ...........................................................................................................30
Validiteit ........................................................................................................................30
Doorbreek de meetlast: meten is weten maar mag geen last worden. ..............................31
MVG .................................................................................................................................31
❖ De registraties omvatten: ....................................................................................31
Hoe is het registratie-instrument van de VG-MZG opgebouwd ......................................31
❖ Structuur .............................................................................................................31
❖ De domeinen ......................................................................................................31
❖ De klassen (eerste karakter VG-MZG code) .......................................................32
• Domein 1 Elementair fysiologische functies ....................................................32
• Domein 2 Complex fysiologische functies .......................................................32
• Domein 3 Gedrag ............................................................................................32
• Domein 4 Veiligheid ........................................................................................32
• Domein 5 Gezin en familie ..............................................................................32
• Domein 6 Gezondheidszorgstelsel ..................................................................32
Wat is een uitgevoerde verpleegkundige interventie? ....................................................33
Welke uitgevoerde verpleegkundige interventies worden geregistreerd ........................33
Wat is een verpleegkundige zorgperiode? .....................................................................34
Veel voorkomende definities in de codeerhandleiding: ..................................................34
❖ Zorgverlener .......................................................................................................34
❖ Patiëntendossier .................................................................................................34
❖ Meetinstrument ...................................................................................................34
❖ Significante naaste .............................................................................................34
❖ Educatie .............................................................................................................35
het begrip kwaliteit................................................................................................................10
Kwaliteitsdefinities ............................................................................................................10
Verschillende definitie van kwaliteit ...............................................................................10
❖ De mate van overeenkomst ................................................................................10
❖ De voortdurende inspanningen ...........................................................................10
❖ verantwoorde zorgverlening ................................................................................10
Algemene definitie .........................................................................................................10
Definitie IOM .................................................................................................................10
❖ 8 dimensies: de zorg moet ..................................................................................10
Invalshoek .....................................................................................................................11
❖ Professionele kwaliteit ........................................................................................11
❖ Patiënt/Cliëntgerichte kwaliteit ............................................................................11
❖ Beleidsgerichte kwaliteit......................................................................................11
❖ Sociaal gerichte kwaliteit.....................................................................................11
❖ Ideaalbeeldbenadering .......................................................................................11
Effectiviteit en efficiëntie ...................................................................................................12
Effectiviteit of doeltreffendheid:......................................................................................12
❖ Gebruiker: ...........................................................................................................12
❖ Professional: .......................................................................................................12
❖ Organisatie: ........................................................................................................12
❖ Methodiek: ..........................................................................................................12
❖ Overheid: ............................................................................................................12
❖ Samenleving: ......................................................................................................12
Efficiëntie of doelmatigheid: ...........................................................................................12
De relatie tussen kwaliteit en cultuur .................................................................................12
Normalisatie van afwijkingen .........................................................................................12
Verpleegkundige als verbeteraar ...................................................................................13
❖ Sleutelfiguur: .......................................................................................................13
❖ Valkuilen: ............................................................................................................13
Empowerment patiënt ...................................................................................................13
Kwaliteitszorg in België.........................................................................................................13
Wetmatige- en projectmatige initiatieven...........................................................................13
Kwaliteitsdecreet betreffende kwaliteit van gezondheids- en welzijnsvoorzieningen ......13
❖ Doel ....................................................................................................................13
❖ Krijtlijnen .............................................................................................................13
• Kwaliteitsmanagementsysteem .......................................................................14
, • Zelfevaluatie ....................................................................................................14
Patiëntveiligheid: Clinical Risk management .................................................................15
❖ Doel ....................................................................................................................15
❖ stimulerende organisatiecultuur ..........................................................................15
• betekenis.........................................................................................................15
• meten ..............................................................................................................15
❖ Veiligheid ............................................................................................................15
Een meer systeemgerichte benadering van incidenten ‘To err is human’ ......................16
❖ persoons- en de systeembenadering ..................................................................16
• De persoonsbenadering ..................................................................................16
• systeemgerichte benadering ...........................................................................16
Technologie en patiëntveiligheid ...................................................................................17
❖ Bijvoorbeeld de Elektronische alarmbelletjes ......................................................17
Accreditatie ...................................................................................................................17
❖ Wat is accreditatie? ............................................................................................17
• Accreditatie gaat na.........................................................................................17
❖ Voordelen van accreditatie .................................................................................17
• Intrinsieke factoren: .........................................................................................17
• Extrinsieke factoren – inspelen op: ..................................................................18
❖ Wat is het verschil met visitatie? .........................................................................18
Patiëntentevredenheid, klachtenbeleid en patiëntenrechten ..........................................18
❖ Patiëntentevredenheid ........................................................................................18
• Inzichten in het begrip patiëntentevredenheid .................................................18
• Mechanismen die aan de basis liggen van patiëntentevredenheid ..................19
❖ Klachtenbeleid ....................................................................................................20
• Definitie van een klacht ...................................................................................20
• Onderscheid tussen klager en klacht ...............................................................20
• Klachtenmanagement .....................................................................................21
❖ Patientenrechten.................................................................................................21
• Wettelijke bepalingen ......................................................................................21
• Krachtlijnen van de wet betreffende de rechten van de patiënt ........................21
Methoden en technieken kwaliteitsverbetering .....................................................................22
Visies op kwalitatieve verbetering volgens Berwick ...........................................................22
De theory of bad apples ................................................................................................22
De theory of continuous improvement ...........................................................................22
Basisstappen in modellen van kwaliteitsverbetering..........................................................22
de PDCA-cirkel. .............................................................................................................22
, ❖ Plan: ...................................................................................................................23
❖ Do (uitvoering): ...................................................................................................23
❖ Check (evaluatie): ...............................................................................................23
❖ Act (Opvolging en verankering): ..........................................................................23
❖ cyclische benadering ..........................................................................................23
Kwaliteitsverbetering en -toetsing .....................................................................................23
Stap 1: Doelstelling .......................................................................................................23
❖ S= Specifiek........................................................................................................23
❖ M= Meetbaar ......................................................................................................23
❖ A= Acceptabel ....................................................................................................23
❖ R= Resultaatgericht: ...........................................................................................23
❖ T= Tijdgebonden.................................................................................................23
Stap 2: Opstellen van een werkplan ..............................................................................24
Stap 3: Formuleren en vaststellen van criteria ...............................................................24
Stap 4: Meten van werkelijkheid en vergelijken met wenselijkheid (criterium) ................24
Stap 5: Aangeven van mogelijke oplossingen ...............................................................25
Stap 6: Plan van invoering .............................................................................................25
Stap 7: Toetsing achteraf en eventuele bijstelling ..........................................................25
Voorbeeld: Meten van kwaliteit, formuleren van criteria .................................................25
❖ Probleemstelling: ................................................................................................25
❖ Oorzaken: ...........................................................................................................25
❖ Criteria ................................................................................................................25
❖ Samengevat .......................................................................................................25
Kwaliteitstoetsing volgens Donabedian .............................................................................26
Criteria ..........................................................................................................................26
❖ Structuurcriteria ..................................................................................................26
❖ Procescriteria ......................................................................................................26
❖ Uitkomstcriteria ...................................................................................................26
Indicatoren ....................................................................................................................26
❖ Structuurindicatoren: ...........................................................................................26
❖ Procesindicatoren: ..............................................................................................26
❖ Uitkomstindicatoren: ...........................................................................................26
Kwaliteitsverbetering .........................................................................................................26
Probleemanalyse d.m.v. visgraatdiagram/ Pareto-analyse ............................................26
❖ Visgraat-diagram of oorzaak-gevolgdiagram (of Ishikawa-diagram) ....................27
❖ Pareto-analyse ...................................................................................................28
Technieken bij kwaliteitsverbetering ..............................................................................28
, ❖ Brainstorming .....................................................................................................28
❖ Enquête of vragenlijst .........................................................................................28
❖ Peer observation survey .....................................................................................29
❖ De suggestiebus .................................................................................................29
❖ Het klachtenbeleid ..............................................................................................29
❖ De WWWWHW-methode ....................................................................................29
❖ De kostenbaten analyse .....................................................................................29
Meten is weten .....................................................................................................................30
Wat is een meetinstrument ...............................................................................................30
Efficiëntie.......................................................................................................................30
Standaardisatie .............................................................................................................30
Normering .....................................................................................................................30
Objectiviteit....................................................................................................................30
Betrouwbaarheid ...........................................................................................................30
Validiteit ........................................................................................................................30
Doorbreek de meetlast: meten is weten maar mag geen last worden. ..............................31
MVG .................................................................................................................................31
❖ De registraties omvatten: ....................................................................................31
Hoe is het registratie-instrument van de VG-MZG opgebouwd ......................................31
❖ Structuur .............................................................................................................31
❖ De domeinen ......................................................................................................31
❖ De klassen (eerste karakter VG-MZG code) .......................................................32
• Domein 1 Elementair fysiologische functies ....................................................32
• Domein 2 Complex fysiologische functies .......................................................32
• Domein 3 Gedrag ............................................................................................32
• Domein 4 Veiligheid ........................................................................................32
• Domein 5 Gezin en familie ..............................................................................32
• Domein 6 Gezondheidszorgstelsel ..................................................................32
Wat is een uitgevoerde verpleegkundige interventie? ....................................................33
Welke uitgevoerde verpleegkundige interventies worden geregistreerd ........................33
Wat is een verpleegkundige zorgperiode? .....................................................................34
Veel voorkomende definities in de codeerhandleiding: ..................................................34
❖ Zorgverlener .......................................................................................................34
❖ Patiëntendossier .................................................................................................34
❖ Meetinstrument ...................................................................................................34
❖ Significante naaste .............................................................................................34
❖ Educatie .............................................................................................................35
