Management of sickness absence: a quality improvement study from Slovenia

Problem A need to improve the communication system between general practitioners (G Ps) and the national health insurance institute's (NHII) committee of exper ts for the referral and approval of sickness leave for patients. Design A structured low cost quality improvement method for motivating GPs to chan ge their current practice was developed. Background and setting The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and e ffect diagram. The study period for baseline data collection was from Novem ber 1996 to December 1996, and the re-evaluation rook place in May 1997. All GPs in Kranj health district (n=78) took part. Data were collected on 4 43 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase. Key measures for improvement Reducing the number of cases reported by members of the committee of expert s as causing problems after the intervention. Feedback to GPs about the suc cess of the process. Strategies for change A combination of methods was used: posted feedback, a guideline on record k eeping, and a guideline, called AID (analysis of incidental deviations from expected service-in Slovene: analiza izjemnih dogodkov), on processing med ical documentation. Effects of change An overall drop was observed in the number of cases that caused problems (f rom 44% to 26%, p<0.001). The most common problem at baseline (19.4% of the problems) wats the seventh most common at the re-evaluation, then contribu ting only 9.2% of total problems (p=0.02). Lessons learnt The results support a quality improvement philosophy that empowers "owners" of the process to be the key resource in managing change, and they show th e importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing t o improve their performance. Nevertheless, structures and funding are neede d to foster quality improvement initiatives and implement national policy o n quality in health care.