In fulfilling its triple mission of care, teaching and research, HUG is guided by four values, among which quality illustrates a particularly rigorous internal policy, focused on care safety and efficiency.
A mediation space, for listening and talking, provides patients and their families an opportunity to express any challenges they encounter during their hospital experience. This space also aims to engage patients in improving care quality.
As a guarantee of this commitment, the Service of care quality is responsible for promoting the quality of care at HUG and meeting the needs of the population as effectively as possible. It contributes to quality improvements in the following areas:
- Care processes
- Patient satisfaction surveys
- Incident management
- Patient information
- Care quality indicators
Care processes
The clinical pathway is a detailed description of the stages involved in a patient’s treatment for a specific illness, procedure, or dependency situation. It sets out each stage's duration, objectives, involved professionals, and required actions (treatments, care, information, etc.)
The primary aim of the clinical pathway is to enhance the quality and efficiency of care, mainly by reducing practice variability for patients with the same diagnosis. It is based on clinical best practice recommendations and considers the local context.
Generally, clinical pathways are used for high-volume patient settings with varied care approaches that require a multidisciplinary team. This methodology facilitates coordination and integration of care.
Several clinical pathways have been developed, including those for heart failure, breast cancer, total hip replacement, back pain, peripheral artery disease, lung cancer, primary liver malignancies, and dementia.
In addition, six dimensions have been identified to achieve a more comprehensive mastery of care quality:
- care safety : measuring and reducing care-related risks, such as infection and nosocomial disease risks
- efficiency : optimal use of resources, skills, and equipment
- effectiveness : including the implementation of clinical pathways that detail the stages of patient care for specific conditions or procedures
- equity : ensuring high-quality care for all patients without distinction
- patient as partner : delivering respectful care that honors the individual’s preferences, needs, and values
- timeliness : reducing waiting times for patients
Patient satisfaction surveys
Patient satisfaction is a recognized indicator of service quality.
HUG began conducting institutional satisfaction surveys in 2001 and has carried them out annually since 2010.
These surveys are conducted among all adult patients residing in Switzerland, hospitalized for more than 24 hours within a specified period, after their discharge from HUG. Patients are contacted about four weeks after their discharge, with approximately 3,000 patients surveyed and a response rate exceeding 50%.
The questionnaire used is developed by the Institut Picker, comprising 44 questions organized into 9 dimensions of satisfaction:
- Emotional Support
- Respect for the Individual
- Family and Loved Ones' Information
- Patient Information
- Specific Information in Surgery
- Physical Well-being
- Discharge
- Treatment Coordination
- General Impression
Occasionally, additional questions are included to address specific HUG concerns, such as pain management, feelings of safety, hotel-like services, and discharge organization.
Results are presented as problematic values, such as responses like “Yes, sometimes” or “No” on a scale including “Yes, always,” “Yes, sometimes,” and “No.” These values are presented by care service (or group of services) and compared to previous survey values. Presenting results by care service encourages teams to take ownership of results and to drive improvement projects.
The results indicate that patients are least satisfied with discharge organization, the information they receive, and the opportunity to express concerns.
Any patient dissatisfaction is a concern for HUG. Thus, maintained efforts in patient information, clinical pathways, safety (incident analysis training, incident groups), and discharge planning are expected to improve patient satisfaction in the coming years.
Incident management
HUG has implemented an incident management system for which all staff members receive specific training.
This management is organized within departments, where incident groups are made up of staff and supervisors. Reporting an incident is voluntary, and the confidentiality of those reporting incidents is guaranteed, as is disciplinary immunity for those involved in the incident.
An online software application via the HUG intranet allows incidents to be reported from any workstation.
On average, 7,000 incidents are reported annually, covering all activities, including patient care and logistical processes.
This process is part of HUG's overall risk management concept. It is complemented by the management of serious adverse events, for which accident reporting is mandatory and may lead to administrative sanctions.
Analyzing these situations is a valuable source of information for improving patient safety.
Patient information
Care departments are encouraged to provide relevant and accessible information materials to patients. They are supported in their creation of quality brochures, apps, and videos that meet current international standards, by the Patient and family information group (GIPP), which includes physicians, nursing staff, and health communication specialists. It also includes patient partners.
All documents produced undergo scientific validation and are tested by those directly affected by the information.
Care quality indicators
To benchmark their performance against other institutions, HUG uses dashboards. These tools support decision-making by guiding strategic choices and tracking needed improvements.
HUG is also required to provide data to:
- The State of Geneva : the service contract lists indicators across five areas of activity (patient services, clinical organization, medical, technical, human, and financial resources), including the eight indicators defined by H+.
- Federal Authorities : the revised LAMal law requires reporting on six indicators.
H+ Indicators
As H+ members, HUG utilizes the indicators established by the Swiss National Organization for hospitals, clinics, and public and private Care Institutions:
- Nosocomial Infections : HUG remains within international standards (5.8% in 2017).
- Mortality : measured using methods from the Federal Office of Public Health (FOPH) and HELIOS (concept developed by German clinics).
- Number of Cases per Medical Discipline : according to FOPH medical statistics.
- Falls : fall rate (2017, 2-4 falls per 1,000 patients in acute care, 7-10 in geriatric and rehabilitation sectors).
- Pressure Ulcers : HUG recorded a 6.4% rate of pressure ulcers in 2017.
- Rehospitalization : HUG participated in an ANQ and H+ project to develop an indicator for avoidable readmissions across hospitals. The latest available results, published in 2015, show an observed readmission rate below the norm (4.07 instead of 4.53).
- Complications : as part of the ANQ and H+ project, an indicator for reoperation rates was established for a sample of Swiss hospitals, including HUG. The latest available results, published in 2015, show an observed reoperation rate below the norm (2.90 instead of 3.04).
Patient-centered quality
Launched in 2012, the Patient-centered quality (QuaP) project aims to support teams in improving patient care quality by fostering knowledge and experience sharing. All care units are visited by pairs of supervisors, including at least one physician or nurse. The visits aim to: foster exchange between staff and supervisors; identify strengths of units; highlight areas for improvement; reinforce awareness of best practices; and contribute to a shared vision of quality.
Quality Days
Since 1999, the HUG's Quality Day has aimed to inspire, encourage, support, and promote staff-initiated projects that improve the quality of care, services, and operations.
Every Quality Day, a Quality Award is presented by the jury to a team or individual who has successfully completed a quality improvement project.
Until 2004, only medical and nursing units could present projects. Recognizing that many other sectors contribute to quality improvement, organizers decided to open the event to all HUG departments. Quality Day now reflects all initiatives within the institution, inviting medical services, nursing, multidisciplinary health professionals, shared services, and operational departments to submit projects, ideas, and even their “dreams” related to patient care.
