Accepted by the board of the Finnish Medical Association March 28,
1996 The purpose of health care is to treat illnesses and to maintain and
promote the health of the population. The goal of quality assessment in health care is
continuous improvement of the quality of services provided for patients and population and
of the ways and means to produce these services. The obligation to continuously improve ones 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
based on medical knowledge and experience. Quality aspects are included also in the act
concerning patient´s statutes and rights. The act takes for granted patient´s right for
high quality health care. The act concerning health care professionals includes provision
according to which a health care professional must maintain and improve his\her
professional skills required to engage in his\her professional activity. Employers of
health care professionals shall according to the same act create opportunities for a
health care professional for participation in necessary professional further education.
The fulfilment of these prerequisites has to be followed by assessment. Physicians and health care institutions have to strive for
continuous improvement of services. The purpose of these guidelines is to strengthen this
pursuit by means of quality assessment practices and to create ethical grounds for audit. Ethical guidelines for quality assessment concern all physicians,
institutions providing health care services for patients and producers of audit services. Every physician involved in patient work, other health care
professionals and institutions and the whole health service sector have to aspire for
continuos development of their work. A physician and an institution have to evaluate the
quality of their work, activities of their unit and the level of staff´s ability and to
be ready to set them under independent external audit. Those involved in patient work have to look after necessary
preconditions for good quality work and evaluation of the quality of the work. The
equipment of an institution and the dimension of staff have to meet requirements of good
quality activities. Patient records have to be written and preserved with care taking
into consideration the obligations for secrecy. Procedures, decisions and other matters
connected with patients have to be recorded in due form so that information and events can
be traced back. The personnel of institutions have to have adequate possibilities to
maintain and develop their knowledge and skills. Recommendations and guidelines have to be
available for those needing them. It is recommended that institutions would create quality
manuals for their own use and supervise that instructions included in them are followed. Every physician has to continuously evaluate the quality of his/her
work and the level of ability by self-assessment methods. The quality of health care has to be assessed by both internal and
external methods. The methods have to be generally approved and they have to be based on
research or sufficient knowledge. Internal audit, observation of examination and treatment methods,
comparison with others, observation of organisation´s ability to act and observation of
the feedback from patients have to be continuous activities belonging to every service
provider. External audit, such as external peer review and audit, has to be
carried out with a frequency corresponding to the evolution of the field and always when
there is special reason for that. The patient records can be used in quality assessment. This requires
that patient information to be kept in secrecy shall not reach inappropriate persons. All
reports and comparative data have to be presented in such a form that patients under
assessment cannot be identified. A precondition for successful assessment is the free will of
institutions and physicians to be assessed and their commitment to assessment. It is
recommended that an informed voluntary consent is acquired from those to be assessed. The results of assessment belong to those subscribing the
assessment. They can be used for comparisons and general purposes only with the approval
of the subscriber and those involved in assessment. A provider of services can inform its customers about the results of
quality assessment and use them in marketing its services. The assessment of the work of an individual physician is the
responsibility of the physician him/herself and his/her superior. Information regarding
individual physicians should not be published without the consent of the physician
concerned. An external assessor shall not give the results of assessment or
other information revealed during assessment to others without a permit from the
subscriber of assessment. Generally approved ethical principals of health care and the ethical
codes and collegiality codes of the Finnish Medical Association have to be followed in
quality assessment. If ethical issues in an assessment project raise doubts can an
ethical committee be asked to give a statement. Submitting assessment projects for
approval by ethical committees is, however, mainly not necessary. The assessor has to be competent and experienced in the field that
the assessment concerns. He/she has to be accepted by those to be assessed whenever
possible. The chosen assessor has to be impartial and independent. He/she has
to be well acquainted with the activities of those to be assessed. In his/her statement
the assessor has to be objective, the conclusions have to be based on observations and
their critical evaluation and to other facts that he/she has acquired. The assessor must
not allow e.g. commercial or competitive matters influence the content of his/her
statement. Quality assessment 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 assessment. The results of assessment can be used
for the purposes of supervising authorities only by a separate mutual agreement. The Finnish Medical Association supervises the compliance the
ethical guidelines for health care quality assessment. The quality board of the Finnish Medical Association develops the
guidelines and interprets them when necessary and gives statements about complying with
the guidelines. If a physician notices deficiencies in the quality of services of
his\her colleagues or institutions it is his responsibility to take action by discussion
with the physician involved, his/her superior or representatives of the unit. If this does
not lead to a result, the physician should inform the Finnish Medical Association about
the matter.ETHICAL GUIDELINES FOR THE QUALITY ASSESSMENT OF HEALTH CARE
Purpose of the guidelines
Application of the guidelines
Obligation for quality assessment
Preconditions for good quality work and its assessment
Realization of assessment
Secrecy of patient records
Confidentiality of assessment
Ethical committees
Competence of the assessor
Impartiality of the assessment
Assessment and supervision by authorities
Supervision of ethical guidelines for health quality assessment
Förbund
The Finnish Medical Association -
Health Care and the Medical Profession in Finland
Association
