implementation of quality standards into practice: czech republic josef radimecky european...

Implementation of quality standards into practice:

Czech Republic

Josef RadimeckyEuropean conference - Building and EU consensus for minimum quality standards in DDRPlenary session III: Translating standards into practice15-17 June 2011, Brussels

19.04.2023page 2 Czech Standards and Certification

Content

‘Heritage’ of communism

Implications for drug services and standards of quality

Standards of professional eligibility

Czech vs. EQUS

Certification of services – basic terms

Main goals of drug services certifications

Basic principles of certification

Key players of certification process

Process of certification

Evaluation of certification process - lessons learned

‘Heritage’ of communism


1948 - 1989

communisms - ‘ideal classless’ society’ – no social problems…

drug use - depraved ‘capitalist style of life’ – tabooed

drug users - public enemies of the society – persecuted

everything under control of the state – no NGOs

‘Spirits lead back to capitalism, and not forward

towards socialism.’ V. I. Lenin

Czech society - little knowledge about drugs and responses

lack of experts

lack of prevention & treatment services, no HR

compulsory treatment of drug addicts exclusively by psychiatrists

inappropriate legislation – drug policy and services, NGOs (1989)

Implications for services and standards

Year Activity

1993 National Drug Commission and Launch of the Czech Drug Policy – aiming to establish missing types of services

1995 Minimal Standards for Drug Services (DDR, HR) – initiative of NGOs

1999 Preparation of Standards for Drug Services Certification – WGs for individual types of services

2001-02 Phare Twinning with Austria – Task Force Certification

2003 Approval of Certification System, 1st trainings of certificators

2005 Launch of Certification of Drug Services, 2nd training of certificators, Approval of standards for drug prevention

2007 Evaluation of the System of Drug Services Certification after 2 years, Launch of Certification of Drug Prevention Services

2011 Revision of standards and process of certification19.04.2023page 4 Czech Standards and Certification

Standards of professional eligibility


General part (all types of services)

Accessibility of professional services

Patients/clients rights

Admission and initial assessment

Spectrum and principles of provided services

Human resources management

Management and education of staff

Availability and external relations

Organization of services

Financial management

Service environment

Minimal safety

Evaluation of quality and efficiency of services

Special part (acc. type of services)

Detoxification

Out-reach programmes

Low-threshold centres

Out-patient treatment

Stationary programmes

Short- and mid-term rezidential treatment

Rezidential care in therap. communities

After-care programmes

Substitution treatment

2007 Drug prevention services

Czech vs. EQUS

Level 1: interventions

Level 2: services Level 3: systems & policies

Structural quality Type of setting needed for implementation

Resource standards

Legal & ethical adequacy standards

Process quality Implementation standards

Procedural standards

Standards for networking & cooperation among services

Outcome quality Effectiveness standards

Effectiveness standards

Coverage standards

Benchmarks Cost-benefit ratio

Cost-utilization ratio

Cost-effectiveness ratio


Outcome quality and Benchmarks – not assessed within assessment of services quality (other instruments), no clear standards set up,

Certification of services – basic terms

Drug services – interdisciplinary complex of health, social and/or educational interventions provided to drug users and/or their close persons.

Certification of professional eligibility – examination and formal recognition – drug services provided in line with good practice (criteria of quality and complexity).

Process of examination of drug services by external peer evaluators with the use of shared and officially approved standards.


Main goals of drug services certifications

to contribute to:

an improvement of quality of drug services in benefit of their clients (+) ;

an integration of drug services into the system of health and social services in order to minimise risks of marginalization of their clients (-);

a fulfilment of state responsibility in quality assurance of services provided and funded from public sources (+);

an efficient funding from public sources (+/-).


Basic principles of certification

voluntariness – certification is not obligatory, services providers ask for it and co-finance related costs – vs. obligation only for NGOs – condition to receive funds from public sources;

transparency – process runs within predefined and by National Drug Commission approved conditions;

independency of examination – examination of services organized by an independent NGO Certification Agency and external peer evaluators;

unity and inter-disciplinarity of criteria – shared and approved inter-disciplinary standards used for examination


Key players of certification process


Services providers

&their clients

Team of peer examinators

Certification Agency

Secretariat of NDC

Committee for Certifications

National Drug Commission

Nomination of team members, Report from examination – findings and recommendation with regard to certificate

Conclusions from examinationDecision about certification

Appeal against team of examinators composition

Appeal against decision of Committee for Certifications

Application for certification

Local examination

Process of certification


1

2

3

4

5

6

7

8

Provider of service applies by Certification Agency for certificate

Day of application submission – start of certification process

Certification Agency – nominates team and set up a term of examination (in 30 days from submission)

Assessment of service documentation prior on the spot examination of service - 1-2 days – team prepares protocol signed by both sides

Team elaborates more in depth report from examination within 10 days with final recommendation

Certification Agency receives protocol and report from exam. team and submitt it to Committee for Certifiication via Secretariat of NDC

Committee for Certifications discusses proposals submitted by Certif. Agency

Within 30 days Committee for Certifications informs provider of service about final decision 9

Committee for Certifications:

• certificate for 3-4 years

• conditional certificate (e.g. for 1 year and consequent re-

examination)

• no certificate

Certificate of professional eligibility

Drug services examination

3 trained peer examinators – experienced (practitioner, manager, civil servant – not in conflict of interests);

1 – 2 days of examination – size of the service

sources of examination:

programme documents (sent to team in advance + submitted on the spot),

observation,

interviews with manager, staff and clients (cross-checking written vs. reality);

examination – „fresh eyes“, support, sharing of experience, advice, recommendation for change


Lessons learned

evaluation of the process after 1st phase (2005-06);

65 examinators/certificators trained and involved

64 organizations providing 150 services certificated

questionnaires – services providers + examinators:

proces of examination (preparation, examination, conclusions)

examinators (ethics, professional skills)

organization and dissemination of information about the process

pros and cons of participation in the process of certification

proposals for change


Main findings

Certification – contributed to an improvement of drug services quality:

„systematic elaboration of services provision step by step…“

„showed gaps we haven´t seen before…“

„gave a feed-back to management of services – what to do in order to assure quality of our services…“


Strenghts of certification

documents clearly defining the whole process of certification, roles of its participants – clear, understandable and transparent

coordination of the process by the Certification Agency – communication with both examinators as well as providers

professional approach of examinators/certificators

continual learning by doing


Weaknesses of certification

some documents – room for improvement – i.e. how

to proceed in specific situations within examination

General standards – some overlaps

from examinators point of view – weakest part –

further education for examinators

duplicity in drug services evaluation – National Drug

Commission standards vs. standards for social

services MoSA (5 out of 9 drug services)

unequal opportunity – NGOs vs. state providers of

services not obliged to meet standards


Thank you for your attention!

Contact:

Dr. Josef Radimecký, PhD., MSc.

Centre for Addictology

Psychiatric clinic, 1st Medical Faculty,

Charles University in Prague, CR

E-mail: [email protected]

www.addictology.org

Mobile: +420 724 240 778


mailto:[email protected]

http://www.addictology.org/

implementation of quality standards into practice: czech republic josef radimecky european...

Documents

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brussels czech standards

approval of standards

clear standards

czech drug policy

minimum quality standards

drug services ddr

drug prevention2007evaluation