Implementation of care standards
When a multitude of guidelines were introduced in the field of mental
health in the past decades, implementation proved to be a slow and
difficult process. A multi-faceted approach is mostly promoted as the
best strategy with actions targeted at the professional level (training
programs, educational material, access to peer information about good
practice experiences), the organizational level (introduction of care
pathways, tools for cost estimation) and the patient level (information
brochures or option grids). A multitude of resources and tools to help
to implement guidelines has been developed but implementation is still
work in progress. Continuous efforts and financial incentives are
necessary to optimize the use of guidelines13. Whether
improved adherence to guidelines, will improve quality of care and
patients outcome is open to debate and a little researched
question4.
Although the implementation of the number of standards seems to be an
obstacle for some, it can also be an advantage. There might be some
advantages with implementation of the standards compared to
implementation of guidelines. The introduction of elements of clinical
expertise in the standards might enthuse clinicians more than before to
adapt to these standards as they represent the daily clinical practice
better. At the same time, patients will recognize more elements of
experiential knowledge in the standards and the associations of patients
representatives might enforce the use of these standards much stronger
than the guidelines before.
Where NKO previously supported the field in the development of
standards, Akwa GGZ14 now supports mental health care
on a national level with the implementation of these standards. For all
standards of care a test was carried out among clinical practitioners to
assess the practicability of the care standard and the conditions that
are necessary to implement the care standard. With that information Akwa
GGZ has developed implementation plans that includes strategies to
inform professional organizations how to use the standards; there is an
online database where all standards can be found and searched; all
standards have been translated to version for users which are on-line,
there is an toolkit with strategies to help the implementation and Akwa
GGZ will monitor the process of implementation of the standards. This
nationwide, encompassing and structured program for implementation might
help the implementation process further. But the professional
organizations are responsible for the actual implementation. Insurance
parties probably will be an active promotor of implementation as the
care standards do represent the best care as possible. The goal is that
professionals, patients and their families know and use the practice
guidelines in daily practice; that professionals and providers learn
from each other by exchanging information and that the quality of care
in Dutch mental health care as a whole will improve.
In conclusion, the process of the development of care standards and
generic standards in the Netherlands is an important next phase in the
ongoing challenge to improve the quality of care for mental health
disorders with evidence based medicine. Some of the difficulties that
arose in the guideline development in the early phase like the multitude
of different and sometimes conflicting monodisciplinary guidelines, the
limited scope of the monodisciplinary guidelines and the omission of
clinical expertise and patients preferences in the guidelines are
addressed by this nationwide, multidisciplinary, integrated new set of
standards of care and generic standards, all developed by the same
methodology with a strong influence of patients and families, and
acceptance by the different health care insurance companies. Still,
there are important challenges for the future because the consequences
of implementation of the standards (for example the financial
consequences) are not fully identified. Furthermore, the question how to
update the standards of care is as relevant as it was for the clinical
guidelines5. Finally, the efforts and expenses for the
development and implementation of these standards can only be justified,
if it really improves the care for those with mental disorders.