Year : 2000 | Volume
: 11 | Issue : 1 | Page : 64--71
Best Practice Hospital: A Model for Cooperative Exchange of Information in the Field of Nephrology and Transplantation
Annelies Fitzgerald1, Harald Thurnher2, Robert D Fitzgerald3,
1 Institute for Training and Projects in Health Services, Vienna, Austria
2 Technokontakte Vienna, Austria
3 Ludwig Boltzmann Institute for Economics of Medicine in Anesthesia and Intensive Care, Vienna, Austria
Institute for Training and Projects in Health Services, Lerchengasse 36/10, A-1080 Vienna
The rapid development of new technology in the health care system is often contrasted by the difficulties in implementing a new system or program in an existing setting. A valuable means for bypassing these difficulties is the direct transfer of knowledge and practical experience from successful users and developers to those interested in initiating the use of the same system. We describe a system of knowledge and information transfer - Best-Practice Seminars - that is successful in surpassing many of the obstacles in implementing and managing change in the health care sector.
|How to cite this article:|
Fitzgerald A, Thurnher H, Fitzgerald RD. Best Practice Hospital: A Model for Cooperative Exchange of Information in the Field of Nephrology and Transplantation.Saudi J Kidney Dis Transpl 2000;11:64-71
|How to cite this URL:|
Fitzgerald A, Thurnher H, Fitzgerald RD. Best Practice Hospital: A Model for Cooperative Exchange of Information in the Field of Nephrology and Transplantation. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2020 Jul 13 ];11:64-71
Available from: http://www.sjkdt.org/text.asp?2000/11/1/64/36696
Never before has our knowledge in practicing health care been so deep, technology so advanced, or communications so fast and wide. However, there is ample evidence to suggest that implementing such new systems and methods of providing health care within the existing structure has, so far, been fraught with difficulties.
Exponential growth in new knowledge and technology in relatively new specialties such as Transplant Medicine render them even more prone to these problems. The rapid expansion necessitates a parallel system for inauguration of these new structures and programs. Unfortunately, introducing and maintaining new methods of practice, especially in the health care setting, require a great deal of persuasion and resources, and has often led to a negative outcome and wasteful of valuable resources.
One of the popular methods to overcome problems in implementing new projects is to hire external consultants. Although these consultants are experts in many aspects of these projects, they often lack insight into the innate features of the system where the new program is to be implemented, again leading to delay and even non-implementation.
There is no easy solution. However, certain problems in providing health care are common to many institutions. One of the better methods to reduce these, often avoidable, problems is to learn from those who already have successfully implemented a new project or program in their institution. A consistently successful approach in this field has been found to rely on the exchange of experience, sharing of problems, and reaching collective solutions. 
Such a process of mutual exchange of valuable information and incentives prevents a 'reinvention of the wheel' on one side and provides for excellent feedback for further improvements on the other. Programs enabling and supporting this process are called Best-Practice-Programs and have been used in many countries in industrial and commercial settings. (All over the world programs based on these principles are going to use the opportunity to release a new wave of innovation). The aim of this paper is to describe this system of cooperative exchange of information or the 'Best-Practice Model', and to outline some completed projects.
Best Practice Program as a technology transfer project for industry and commerce: the Austrian experience
In Austria, a Best-Practice project is sponsored and supported by the Austrian Federal Ministry for Economic Affairs. On their behalf a private company (TechnoKontakte, Vienna) is concerned with the execution of a Best-Practice technology transfer project for industry and commerce. The program appeals to executives, project managers as well as research and development managers from private and state-owned national and international companies. The program was initiated in September 1995 on the basis of the encouraging international examples to force the exchange of experience and research information in Austria. The first seminar took place in February 1996. Since then more than 60 companies and about 1500 participants joined the project. The interest to participate in this program is magnificent and external evaluations objectively showed that this form of information and technology transfer is highly efficient. The organizing company - TechnoKontakte - is part of the "EUNET-TOP" project (European Network for Technology and Management Oriented Programs). EUNET-TOP encourages the spread of the programs with firm-to-firm visits in the countries Austria, Germany, France and Spain. Furthermore it cooperates with IUKE (Inside UK Enterprise) in the United Kingdom and other initiatives in the Netherlands and Canada. These links form the base for the further development of EUNET-TOP to a pan-European project for the promotion of the exchange of techno-logical and strategic management knowledge between companies of different European countries and cultures.
The success of the Technokontakte Program is displayed in [Figure 1],[Figure 2]. Data are based on the evaluation of the independent Seibersdorf Research Institute. Almost 80% of the participants said that the visit program met the needs of their companies. The evaluation of the program showed that the seminars were rated best in easy unders-tanding (100% high/medium), practice orientation (98% high/medium), originality of the information (63%) and in the possibi-lity of exchange of information between visitors. For 100% of the visitors the most important expectation was, to receive practice orientated information during the seminar. 33% put importance on the exchange of experience between the participants. 'To get an insight into the host company' attracted 29% of the visitors. The possibility to get into contact with other visitors and persons from the host company played an important role for 20%.
"Best-Practice" in Health Care
The great success of Best-Practice Programs has led to their rapid introduction in health care delivery systems. A short overview of some programs in different countries is described below to summarize the different activities on this topic.
The Faculty of Medicine of the Universite de Sherbrooke, Quebec, Canada developed the Autocontrol Methodology in order to support the optimization of decision-making and the use of resources in the context of a clinical unit. In this methodology they distinguished three types of evidence neces-sary for practice change: (i) practice-based (or internal evidence), (ii) best evidence derived from the literature (or external evidence) concerning the practice in question, and (iii) process-based evidence on how to optimize the process of practice change. 
"Best Clinical Practice", a National Quality Management Program of the Military Health Services System of the United States has undertaken a series of projects whose objectives are the active, on-going monitoring and improvement of the effectiveness and efficiency of the care provided to a broad population that encompasses troops on active duty, retirees and dependents . It includes different parts such as the identification of procedures of interest, evaluation of outcomes, report card for the information transfer in the hospital to obtain the 'best clinical practice'. Practice guidelines are developed in an outcome-based process.
A "best practice" demonstration program for monitoring nursing services in remote locations was described by Wilks, at the School of Law, Bond University, Gold Coast and Australia.  This best-practice program resulted in a marked improvement in the quality of patient records.
Bailey described the combination of 'best practice' and the quantitative approach for the development and evaluation of critical paths  to manage healthcare delivery and to ensure favorable patient outcomes.
The evidence-based approach from the School of Health and Community Studies, Sheffield Hallam University, England, is a coordinated approach to ensure that the information on effectiveness of interventions is made available to those in a position to use it. This would allow policy makers, administrators and nurses to base decision-making on the best available evidence. 
IPRO, Lake Success, USA is a Health Care Quality Improvement Program with the aim to develop information on patterns of care and outcomes, to share this with health care providers, and in so doing to effect measu-rable improvement in care and outcomes. In order to achieve improvements in the quality of care, IPRO has initiated a series of cooperative projects, which combine pattern analysis and feedback. They have demonstrated that IPRO, providers, and physicians can collaborate to establish and implement efforts to achieve the ultimate goal of improved quality of care for Medicare beneficiaries. 
Plsek, described how clinicians could use methods to impact clinical practice. Improve-ment teams from a variety of heath care organizations have reported the successful use of basic methods such as group work, flowcharting as well as collection and graphical analysis of data. In addition to these incremental problem-solving methods borrowed from the industrial practice of improvement, they have also seen the use of specific process design methods in health care applications such as care path develop-ment. They reviewed a new philosophy of measurement that has emerged from recent improvement thinking and described the use of control charts in the improvement of clinical care.
Benchmarking and multi-organizational collaborative are more recent innovations in the ways we approach improvement in health care. 
Best-Practice-Hospital - what is it about?
International trends for improvements in medical health care systems concentrate on two major topics: (i) the increase of patient satisfaction, and (ii) the increase of efficiency. The achievement of these goals is based on the improvement of the two cornerstones of improvement processes: quality and information.
Quality seeking is often regarded as an obvious objective in hospital practice and indeed is the natural goal of every clinical intervention. However, being medical specialists we often underestimate the importance of many manifestations of quality, which include structural quality (e.g. buildings, medical equipment, and qualification of staff), process quality (e.g. work process and organizational structure), and outcome quality (e.g. clinical outcome and patient satisfaction). 
The improvement of quality depends on the realization of several important factors:
External quality comparisons - This means comparing own results with those obtained from similar institutions, having agreed on strategic and goal definitions for the same tasks. This includes mutually agreed-on common goals, methods of documentation and evaluation, and data exchange. 
Internal quality development - This means open exchange of experience in the planning, realization of projects, and evaluation of outcome within the institutions.
Joint formulation of recommendations for the transfer of results . The institutions involved have to agree on common standards for presenting their results in a comparable method. 
A goal-directed exchange of information with other institutions, in both health and non-health sectors (e.g. educational programs), is a pre-requisite for high quality in health care programs. Thus, joint develop-mental initiatives and systematic exchange of information are crucial for strategic decision making in health care systems and solutions for special problematic areas in single hospitals.
In health care systems a multitude of events like congresses, symposia, internal and external workshops are available for the improvement of quality. However, it is often recognized and acknowledged that translating new information into practical work often represents a considerable problem for health care personnel. Even when the new knowledge is transferred into guidelines, the personnel who are expected to work with them display low compliance. 
A possible explanation for this problem might be the fact that most workshops or congresses are directed at a single group of professionals e.g. either the doctors, the nurses or the technicians, but rarely emphasize the co-operation between the different people working in the health care system. Thus, information is often delivered to only one group of staff creating more conflicts with the potential consequences of loss of information and of growth of resistance.
Furthermore, an educational meeting becomes more efficient as more people are involved and prepared to report their personal knowledge and experiences. (A preferable 'practical' design is a setting where the 'practical expert' presents to a small group of people involved in similar tasks. Such an approach promises high outcome).
In business and commerce it was success-fully shown that methods of practically oriented transfer of knowledge, result in higher efficiency. Examples are the "Best-Practice-Programs" initiated and promoted in USA, Austria, Germany, United Kingdom, Spain, Netherlands, Canada and Australia. Proceeding from different starting points and using different techniques they all concentrate on the transfer of 'practical-evidence based' knowledge.
Small groups of visitors' experience on the origin of information
Hospitals which found best solutions for special problems host a small group of visitors and present their solution in a one-day seminar. The goal of these seminars is to demonstrate, under economic aspects, specific efficiency and/or quality improving methods and solutions applicable and interesting to other health care institutions.
As an example, we describe the presentation of a well-organized out-patient clinic. In a one-day seminar, an interdisciplinary team discusses the clinic set-up, its achievements and the problems and pitfalls encountered in the development of their solutions. Visitors of different occupational groups from institutions interested in the implementation of a similar system experience, on site, the successful model in presentations and also in a hand-on visit. The maximal number of visitors should not exceed 20 so that an intensive exchange of information is ensured. However, information transfer is not limited to a one-way direction, and visitors are encouraged to contribute their experiences and questions. The information links created at such meetings are often maintained and could lead to successful and productive co-operations.
a) The Host Institution
The host, as the presenter of a project, profits in many ways:
Working out the presentation requires the host hospital to summarize and conclude their achievements. By joining the Best-Practice program and by presenting their results to an interested and interdisciplinary audience, the institution achieves an image improvement (a competent audience recognizes successful programs). This leads to enhanced incentives for employees to seek excellence in their work.As information transfer is not unidirectional, the host institution can gain important input from the visitor's comments.Planning and preparing for the program presentations give further opportunity for team members to enhance co-operation and to reduce barriers between groups in the host institution.Comparing projects in different institutions leads to more transparency concerning the assignment of external consultants and more efficiency in the co-operation with consultants.New links established at the meetings may lead the host institution to under-take more specific projects.In general, the presentation to the public and acknowledgement of their achievements enhances co-operation and increases corporate identity.
b) The Visitors
The individual visitor not only acquires valuable information but also contributes with his/her remarks in exploring new dimensions of the presented project. Learning from the experiences of others prevents the 'reinvention of the wheel', avoids mistakes encountered by others and saves valuable resources.Comparison with other programs allows evaluation of own achievements. Corrections can be made in time, and superior element of one's own project to those demonstrated may be presented.The arrangement of the meeting offers sufficient room for discussion. Practical questions can be answered immediately.Continuing links and information networks can be established and the dialogue between the hospitals can be intensified.Health care workers from outside the hospital e.g. general practitioners and social service workers, are welcome and have the opportunity to experience insights into practical work of a hospital. This facilitates the co-operation between the hospital and external institutions.
How is it organized?
A typical schedule for a Best-Practice Seminar is a one-day event. A short presentation of the host institution would open the program, followed by an extensive and goal-directed presentation and discussion of the topic. The maximal number of visitors should not exceed 20 persons and no less than 10 persons.
Approximately 20 of these seminars should be held per year in different health care institutions. A committee of national and international experts will choose the topics and institutions to be presented.
Public relation is a very important aspect of "Best-Practice program" and a variety of communication channels are required to achieve this function, which include the following:
A catalogue of the held seminars is an essential component. Published annually, it includes a short presentation of the program, presentation of each hosting institution and the topics, as well as, organizational information.
At a smaller scale, a news-letter reporting successful seminars, current information, short reports on the hosting institutions, special events, information on forthcoming seminars, and a chat-corner for participants and visitors to promote new links. News-letters have been shown to be a motivating measure. The best seminars will be published in a special edition of books.
These publications do not substitute for the more traditional use through regular communication on special topics in the electronic and printed media. Journalists may be invited to seminars to support the public relation function of the institution.
With the increasing importance of the Internet, it is essential that the seminars are presented on own homepage, including links to other participating institutions.
Finally, an annual event for directors and presenters of the hosting hospitals is arranged with the purpose to thank participants for their work and commitment. Usually an annual report on the program can be presented and a "Best-Practice-Hospital Grant" may be awarded for excellent presentations and/or projects.
Evaluation and documentation of the program and the seminars are preferably done by an independent institution.
The Best-Practice Program gives the health care professionals the opportunity to review their approaches to patient care, to share new developments with interested colleagues, to contribute to the reduction of in-patient costs, and to improve quality. The presentation of successful programs would enhance the reputation of an institution and should increase staff motivation. (Thus, the program leads to an activation of resources within the institutions). To ensure success, it is fundamental for all persons involved to feel ownership of the project developments and the implementation of change. Learning about different approaches, extracting useful information and adapting to beneficial inno-vations will enable the provision of a health care system with maximum effectiveness in the 21 st century. For this to happen, it is necessary to initiate partnership and to network for the cooperative exchange of information.
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