Assessing patient safety is an important parameter of quality in healthcare. The adverse events in healthcare constitute a quantitative index and their reduction and prevention is the main aim of healthcare services. In the last decade, the national health system in Greece has undergone major structural reforms amid unprecedented financial and social developments. A number of important steps have been taken to prioritize quality of care and patient safety.
Scope of the public health action plan for patient safety and healthcare quality
The scope of the public health action plan includes the control and management of major risk factors for people’s health, under the responsibility of the state. In particular:
a) the planning, impact assessment and socio-economic evaluation of health practices, programmes and interventions,
b) the management and control of social, behavioral and environmental health risk factors, as well as those arising from climate change and the uneven rural-urban distribution of the population with the main focus on strengthening primary health care at community level.
Key principles of the public health action plan
- the recording of behavioral, social and environmental risk factors for health care provision;
- the monitoring and processing of data and health indicators of the population over time;
- the prevention, protection and improvement of the health of the population and especially of vulnerable groups;
- the control and management of diseases with high morbidity through the development and implementation of National Action Plans for diseases with a high prevalence, such as cancer, as well as the control, prevention and management of rare diseases;
- the planning and implementation of health promotion policies to increase prosperity and life expectancy with a view to support and improve the population’s welfare;
- the introduction and investment in the role of “informal carers”, who take on a significant part of the care of the chronically ill at home, in collaboration with health professionals.
Actions to implement key principles
- the adoption of the recommendations of international organizations and the strengthening of health diplomacy through collaborations with neighboring countries and EU member states;
- the consolidation of public health actions on scientifically substantiated opinions according to bioethics and deontogoly while ensuring citizens’ rights;
- mitigating the effects of inequalities in accessing health care due to socio-economic factors such as poverty, unemployment, old age, disability;
- the recording and mitigation of behavioral risks directly related to modern lifestyle, such as smoking, poor diet, lack of exercise, the use and abuse of alcohol and addictive substances and others hazards, which constitute threats to public health;
- the adoption of effective public health risk prevention policies for children, adolescents and adults;
- mobilizing human resources by creating incentive groups for promoting and adopting health policies that focus on positive choices and healthy behaviors by citizens;
- the adoption of horizontal cross-sectoral policies to improve health defining factors, with particular emphasis on living conditions, working conditions and exposure to healthier artificial and natural environments;
- the promotion and financing of research on public health issues, through lifelong training of public health professionals and the dissemination of good practices;
- the cooperation at central and local level and the strengthening of national central, regional and local public health services to provide programs based on the needs of the local reference population with an emphasis on the vulnerable groups;
- addressing the issue of dependencies on electronic media and applications; and in particular gambling and electronic gambling addictions, as well as addiction to the use of internet and social media;
- providing information and personalized awareness of people with the use of modern technology to adopt attitudes and behaviors, which promote health, and
- substantiated information of citizens for the acquisition of knowledge and the improvement of health literacy to help them make well-informed choices.
Important steps taken to improve efficiency and quality and safety
Some of the steps that have been implemented include the following:
Structural interventions to improve efficiency of the health system
- EOPYY is established in 2011 as a self-governing public entity and operates under the supervision of the Ministry of Health. It functions as a monopsony as it is the sole purchaser of health services, setting the preconditions required for contractual commitments with health care providers;
- Reform of the primary care sector by introducing in 2014 the Primary Health Care Networks (PEDY) to strengthen community health services access through a grid of health facilities (local health units, health centres, rural surgeries) depending on the characteristics of the covered i.e. size, economic growth, epidemiological profile and access to hospital care;
- The implementation of a DRG payment system to remunerate hospital services. The Greek DRG Institute was established in September 2014 to develop and manage a transparent, fair, valid and reliable system for measuring the cost of hospital medical procedures based on international Diagnostic–related Groups (DRGs);
- Emphasis on developing a transparent and efficient procurement system with the introduction of the National Central Procurement Authority for Health (EKAPY), established in May 2017 (law 4472) which is responsible for the national procurement policy in health care sector and the annual supply of products and services to the public health care organizations.
Data collection and monitoring
- Steps to improve health system performance monitoring, including the implementation of the OECD System of Health Accounts, managed by the Hellenic Statistical Authority (ELSTAT), and the development of web-based platforms for collecting and reporting data;
- Establishment of a web-based platform (ESY.net) in 2010 that collects financial, administrative and activity data from public providers on a monthly basis, which are then analyzed by the Ministry of Health;
- Introduction of the national e-prescription system to monitor pharmaceutical appropriateness, consumption and referrals for clinical examinations and tests and ultimately the incurred costs;
- Establishment of the e-disbursement initiative (e-DAPY) by EOPYY covering services, costs and administrative functions of private providers, and the e-diagnosis platform in 2012 for doctors contracted with EOPYY to request diagnostic medical service;
- Establishment in 2010 of the Price List Observatory for the collection and analysis of tenders and technical specifications published by hospitals; prices of common products and services are compared among hospitals, with the aim of achieving greater price transparency, cost control and influence coverage decisions by setting the maximum price ceiling for tenders;
- Development of patients’ registries for chronic diseases with the aim to improve quality of healthcare services for patients.
- The Ministry of Health in collaboration with the medical societies introduce and disseminate clinical guidelines. Only in 2013-2014, 25 new guidelines on obstetrics and gynaecology were produced, endorsed and presented by the Hellenic Society of Obstetrics and Gynaecology, in collaboration with government agencies and other medical societies.
- Emphasis on the development of new protocols for major chronic conditions.
- Greece passed legislation on rare and complex diseases and, in December 2019, it established 18 rare disease reference centres. Nine centres were established in Laiko Hospital, four in Aiginiteio Hospital, one in Attiko Hospital and four in Agia Sofia Children’s Hospital.
- Research and training programmes as well as cross-border collaboration initiatives have benefited from the rapid introduction of e-services and tools.
- Development of the national telemedicine network to cater for the needs of patients in remote areas to access health services.
Patients awareness and information provision
- Introduction of patient’s Electronic Health Record which updates patient’s clinical history, supports and ensures continuity of care and confidentiality, allows access and access management to the patient while helping with the collection and monitoring of quality and performance indices;
- Introduction of the e-RV platform, linked to the e-Healh Record, enabling patients to arrange their appointments with the Primary Health Care Networks (PEDYs) and receive information on availability and waiting time.
- The transposition of the Directive 2011/24/EU into national law and the launching of the National Contact Point for cross-border healthcare which informs domestic and EU patients on the rights in Greece and abroad.
- In the seven Regional Health Authorities (YPEs) around the country, Citizens’ Service Centers (KEPYKA) for health issues facilitate citizens’ access to health services and Units for Quality Improvement set guidelines and protocols for the provision of health services.
- Public consultation on health bills and reforms through the Greek open government website (OpenGov.gr) to improve empowerment of citizens in the decision-making process about the services they need and their treatment options.
Transparency and accountability
A number of institutions are tasked with combating corruption and ensuring transparency and accountability in public administration and the health care sector. These include the General Inspector of Public Administration, the Body of Inspectors for Health and Welfare Services (merged into the National Transparency Authority as of 2019) and the Ombudsman for Health and Welfare, as well as the agency that monitors social health insurance funds expenditure (YPEDYFKA) functioning within EOPYY. Another initiative is the Clarity Programme, introduced in 2010, which promotes transparency and openness of the Greek Government and its policies (Diavgeia). It requires all ministries, public institutions, regulatory authorities and local governments to publish their decisions online.
Within the jurisdiction of the Ministry of Health the following units/services are organized:
- the Department for the Protection of Patients’ Rights at the Ministry of Health (Article 7(2)(d) of Presidential Decree 106/2014, Government Gazette, Series I, No 173), which is responsible for monitoring and overseeing the protection of the rights of patients and persons with psychological problems, investigating complaints and charges and raising awareness about issues surrounding the protection of patients, workers in healthcare units and citizens in general;
- the Committee for the Protection of the Rights of Healthcare Recipients (Article 59 of Law 4368/2016, Government Gazette, Series I, No 21);
- the Committee for the Protection of the Rights of Persons with psychiatric problems (Article 2 of Law 2716/1999, Government Gazette, Series I, No 96, as replaced by Article 11 of Law 4272/2014, Government Gazette, Series I, No 145);
- the Offices for the Protection of the Rights of Healthcare Recipients in ESY-hospitals (Article 60 of Law 4368/2016, Government Gazette, Series I, No 21).
Information sources for quality and safety
- Ministry of Health – Unit for quality assessment, statistical analysis and health data evaluation, email: firstname.lastname@example.org
- National Evaluation Center of Quality and Technology in Health (EKAPTY)
- Greek DRG Institute
- National Central Procurement Authority for Health (EKAPY)
- National Organization for Medicines (EOF)
- Institute of Pharmaceutical Research and Technology (IFET)