Quality improvement in the Estonian health system--assessment of progress using an international tool.

OBJECTIVE

To assess the quality of the Estonian health system with the assessment tool provided by the World Health Organization (WHO).

DESIGN

Situation analysis of health care quality using the self-assessment questionnaire proposed by the Council of Europe and WHO Regional Office for Europe as a framework for evaluating national quality activities.

SETTING

Estonia.

MAIN OUTCOME MEASURES

Four domains for evaluating the national quality activities: policy, organization, methods, and resources.

RESULTS

The quality policy of Estonian health care developed in the late 1990s defines the scope of quality and reflects the different viewpoints of stakeholders. Nevertheless, it is not comprehensive enough, activities planned for the involvement of consumers in defining and assessing quality are lacking, and key roles of institutions in quality improvement and incentives for quality are not clearly defined. At present, the responsibilities for quality assurance are distributed among the different stakeholders, but there is no single coordinating structure or mechanism for facilitating or assessing the implementation of the quality activities. Many regulations are established to assure the quality of health services and to protect patients' rights, but the implementation of voluntary mechanisms for quality assurance should be promoted. Access to the sources of information is good, but there is a shortage of unified quality and performance indicators at the national level.

CONCLUSION

The results of this study indicated the strengths and shortages of the present organization of quality activities in Estonia and the ways for improvement. Strengthening coordination with explicit quality monitoring was found as a key factor for improvement.