1. what challenges does the Care Quality and Patient Safety Act pose to hospitals?
The law that was enacted on 16 June 2023 introduced important changes for health policy in the area of quality. An important part of the regulation concerns new obligations for healthcare providers. Among the most important changes was the requirement for mandatory authorisation as a condition for funding from the National Health Fund. In order to obtain it, it is necessary to fulfil the conditions for the provision of health services and to operate an internal quality and safety management system. It is worth recalling that healthcare entities that have a contract for the provision of services from public funds are obliged to establish such a system by 30 June 2024. In the work on the draft law on quality in healthcare, we proposed that the Accreditation Council, which is appointed for a six-year term and whose remit is to develop accreditation standards, should include representatives of all self-governments of the medical profession. In the government bill, it was "three representatives of practising medical professions from among the candidates put forward by the professional self-governments of medical professions". In the vote at the committee meeting (15 Members in favour, 15 Members against), our amendment unfortunately did not gain acceptance.
2. how can quality indicators in health care contribute to raising standards of patient care and health system efficiency?
It is important to emphasise that the Act introduced quality indicators in three areas, i.e. clinical, consumer and management, and the team established on 4 September 2023 by the Minister of Health is responsible for developing and making recommendations on the implementation of healthcare quality indicators. The indicators will allow a certain parameterisation and measurement of the various factors that will be considered relevant to the standards of patient care and the efficiency of the health system. This will make it possible not only to monitor, but also to compare and evaluate the effectiveness of financed healthcare services both in terms of curative effects, patients' opinions on the organisation of the healthcare delivery process, but also the efficient use of resources and the implementation of management systems.
3 What good practices do you know of in relation to patient safety that could be introduced in Poland?
In the context of ensuring greater safety for patients, we recommend that the concept of diagnostic advice be introduced into the legal system as a medical service that directly increases the quality of the diagnostic and therapeutic process. This advice should be provided by specialists in laboratory diagnostics and would constitute, in the opinion of the National Council of Laboratory Diagnosticians, an enormous support for the doctor and the patient. We would like the diagnostic advice to be provided primarily by diagnosticians with specialisation, as they are the ones with the greatest knowledge in the specialisation. The implementation of advice would be a huge support for the doctor and the patient. A laboratory diagnostician could, for example, in the event of alarming results, additionally order tests without having to wait for a doctor's order. The diagnostician could provide such advice to both the patient who has tests performed on an outpatient basis and could also assist the doctor by participating in the treatment teams that are organised in the hospital. We want to be a support to the doctor and a partner in the diagnosis and treatment process. Such a solution is an example of how we can effectively utilise the extensive knowledge of diagnosticians, gained during medical studies and postgraduate training. I am convinced that such a solution will definitely shorten the diagnostic path of patients, especially outpatients, currently condemned to visits to the doctor's office to obtain a referral for tests, interpretation of results, or possibly another referral to extend the diagnosis. It should be emphasised that laboratory diagnosticians make an important contribution to collaboration with other health professions. The active involvement of laboratory diagnosticians in multidisciplinary teams, also involving patients, can contribute to patient safety. Patient-centred healthcare requires attention to teamwork. Effective collaboration , which requires excellent communication, a clear division of roles and responsibilities, will undoubtedly contribute, as confirmed by global research, to improving the quality of care and reducing the risk of error. It is also necessary to strengthen competences in order to keep pace with the increasing complexity of the healthcare system and the growing demands on the qualifications of medical staff. Therefore, in my opinion, it will be particularly important to strengthen the education systems for medical staff by updating educational programmes on patient safety, among other things, which educate on how to minimise the occurrence of infections by improving infection control. As part of post-graduate education, educating medical professionals on the principles and concepts of patient safety (professional adaptation, training in interpersonal communication skills in teams, training in handling emergency situations). It seems very important to strengthen procedures related to the correct identification of the patient.
4. How does your President assess the role of the Hospital Safety Coalition in terms of improving safety conditions in hospitals?
The Hospital Safety Coalition, which was established in 2021, has an important role to play in promoting and encouraging hospitals to use safe medical equipment. Equally important is the creation and awarding of the 'Safe Hospital is Safe Patient' certificate. This is a guarantee of high safety standards in facilities. The fact that so many public institutions, professional self-governments, institutes and scientific societies have assumed patronage of the project underlines the importance of the Coalition's activities. I am very pleased that by joining the Coalition's Board of Experts in January, I will be able to share my knowledge in areas related to laboratory medicine, safety and quality in medical facilities and management issues in the healthcare system.
5 What standards from the perspective of laboratory diagnosticians are important to ensure the safety of medical staff and patients?
Giving quality and safety in healthcare a strategic importance in a long-term perspective, implemented through the implementation of quality management systems in medical diagnostic laboratories. In this respect, we recommend updating the quality standards of the Ministry of Health and the accreditation standards of the CMJ taking into account the area of laboratory medicine. But we also relate the area of safety to patient safety and the safety of medics. We also point out that the system for registering adverse events and the patient compensation system should be as transparent as possible, while not paralysing the healthcare system. Adequate care for a patient who has suffered an adverse event should be a fundamental element of a well-functioning health care system. On the other hand, many medical procedures, including those related to laboratory medicine, may result in such adverse events, which should be systematised. Such solutions should be worked out by broad consensus in each case. For patient safety, minimum staffing standards should be created for all health professions.
6 What are the most important challenges in the healthcare system in 2024?
In the short term, the National Council of Laboratory Diagnosticians already adopted a position paper in August 2023, in which it identified key recommendations. In the position paper, we indicated both the most important challenges in the healthcare system, but also in an area that is particularly important to us, i.e. laboratory medicine. From the point of view of medical self-governments and the healthcare system, it is important today to restore respect for the principles of cooperation with social partners within the legislative process. So far, a number of draft legislative acts have been referred by the Ministry of Health for an opinion by the NRLL at times which de facto prevented the collegial body of the professional self-government, i.e. the Council, from reaching a position. This violates the Council's statutory right to give an opinion on draft health care legislation. In the case of a very large number of projects, the justification for reducing the time limit for taking a position was a sham and indicated a lack of proper coordination of work in the Ministry rather than the actual occurrence of an urgent and unforeseen circumstance. What is even worse is that this permanent urgency was also applied by the Ministry to projects for which the Minister of Health is obliged to consult the NCLD in advance before issuing them. As a diagnosticians' self-government, in our positions we have strongly objected to the violation of statutory principles and good manners in the cooperation between the Ministry and the Council. In the area of laboratory medicine, we point out the need to amend the Law on Laboratory Medicine. The duration of the Act so far has made it possible to identify the provisions that need to be amended and the issues that should be included in the Act. We declare our readiness to undertake working cooperation with the Ministry in developing such a draft. It is also important for the whole system to undertake legislative work on genetic testing and to regulate the issue of handling biological material, accessibility of genome testing results and patient consent for this type of testing - so that the quality of testing performed is guaranteed and biological material and information about the patient's genome does not end up in unwanted hands. Another recommendation is the establishment of a Team in AOTMiT on the contracting of laboratory tests with a view to further detailed reporting. This recommendation coincides with the content of the resolution of the 6th National Congress of Laboratory Diagnosticians, which, with regard to the financing of laboratory diagnostic services in the health care system, pointed out the need to take active steps to price laboratory tests and determine uniform prices, which could form the basis for direct contracting of laboratory tests.