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Adopted by the 49th World Medical Assembly
Hamburg, Germany, November 1997
Preamble
- The purpose of health care is to prevent, to diagnose or
to treat illness and to maintain and to promote the health of
the population. The goal of quality review in health care is
continuous improvement of the quality of services provided for
patients and the population, and of the ways and means of producing
these services.
- The obligation continuously to improve one's professional
ability and to evaluate the methods used is included in the
ethical codes of physicians. According to them a physician has
to maintain and increase his/her knowledge and skills. He/she
shall recommend only examinations and treatments that are known
to be effective and appropriate according to the state of medical
art.
Purpose of the guidelines
- Physicians and health care institutions have a moral obligation
to strive for continuous improvement of services. The purpose
of these guidelines is to strengthen this pursuit by means of
quality review practices and to create ethical grounds for such
review practices, like clinical peer review.
Guidelines
Application of the guidelines
-
Ethical guidelines for continuous quality improvement concern
all physicians, institutions providing health care services
for patients, and producers of review services.
Obligation for quality review
-
All physicians, other health care professionals (including
health administrators) and institutions have to aspire to
improvement of their work. Active participation by everyone
in clinical audit and in quality review initiatives should
be encouraged. Quality review evaluations can be used for
independent external audit, and with the aim of accreditation.
Standards for good quality work
-
Those involved in work with patients need to specify the
standards necessary for good quality work and for the evaluation
of the quality of the work. The resources and skill mix of
staff within health care establishments should be adequate
to attain the required standards of good quality work
- Patient data, whether recorded on paper or on computer, has
to be written and preserved with care, taking into consideration
the obligations for confidentiality. Procedures, decisions and
other matters connected with patients need to be recorded in
a form which will allow information for measuring specific standards
to be available when needed.
- Health care professionals should have adequate opportunities
to maintain and develop their knowledge and skills. Recommendations
and clinical guidelines should be easily available for those
requiring them. Health care institutions need to create quality
systems for their own use and to ensure that instructions concerning
such systems are followed.
Recognition of quality review
- All physicians should continuously evaluate the quality of
their work and their level of ability by self-review methods.
- The quality of health care can be assessed by both internal
and external methods. The agencies for both processes have to
be widely approved, and the methods used must be generally accepted
and based on research or sufficient knowledge.
- Internal clinical peer review, observation of examination
and of treatment methods, comparison with others, observation
of the organisation's ability to act and monitoring of the feedback
from patients have to be continuous activities undertaken by
every service provider.
- External quality review initiatives, such as external peer
review and audit, should be carried out with a frequency corresponding
to the evolution of the field and always when there is special
reason for it.
Confidentiality of patients records
- Patient records can be used in quality review. Patients should
be made aware of the use of their records in quality review.
Their medical records should be kept confidential and anonymised
and should not be accessible to inappropriate persons. All reports,
photographs, videos and comparative data have to be presented
in such a form that the patients involved in a review cannot
be identified.
Confidentiality of peer review
- A precondition for successful peer review is the freedom
of institutions and physicians to agree to be reviewed and their
commitment to review. It is recommended that informed voluntary
consent be obtained from those to be reviewed.
- The results of a review belong to those subscribing to it.
The results can be used for comparisons and general purposes
only with the approval of the subscriber and those involved
in the review, unless national legislation provides otherwise.
- A provider of services can inform his/her customers about
the results of quality review and use them in marketing his/her
services, provided this is allowed by the law.
- The review of the work of an individual physician is the
responsibility of the physician himself/herself and his/her
superior physician. Information regarding an individual physician
should not be published without the consent of the physician
concerned.
- An external review shall not reveal to others the results
of the review, or other information obtained during the review,
without the written permission of the subscriber of the review.
Ethics committees
- Generally approved ethical principles of health care and
national codes of medical ethics have to be followed in quality
review.
- If doubts are raised about ethical issues in a review project
they should be referred to an ethics committee. However, in
general the routine submission of review projects for approval
by ethics committees is not necessary.
Competence of the reviewer
- The reviewer has to be experienced in the field that the
review concerns and competent in quality development techniques
and in clinical audit methods. When medical care is reviewed,
the reviewer must be a physician. The reviewer has to be accepted
by those to be reviewed, whenever possible.
Impartiality of the review
- The chosen reviewer must be as impartial and as independent
as possible. He/she has to be well acquainted with the activities
of those to be reviewed. The reviewer has to be objective in
his/her report. His/her conclusions should be based on a critical
evaluation of observations and facts. The reviewer must not
allow commercial or competitive matters to influence the content
of his/her statement.
Review and supervision by authorities
- Quality review of health care and continuous quality improvement
of services is a part of the activity of every physician and
institution. The supervision of professional activities made
by health care authorities is a distinct activity and should
be kept separate from health care review. The results of a review
of physicians can be used for the purposes of supervising authorities
only by a separate mutual agreement between the health care
authorities and the physicians concerned, unless national legislation
provides otherwise.
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