Lessons from Holland: hospital visiting as an instrument to assess the quality of obstetric and gynecological care

Abstract

Objective: to assess and improve the quality of hospital based obstetric and gynecological care. Study design: in 1991 a hospital visiting scheme by peers was launched by the Dutch Society of Obstetrics and Gynecology. The present study gives a full description of the scheme and its potential impact on the quality of obstetric and gynecological care in all of the group practices in non-teaching hospitals in the Netherlands ( n=87). Comprehensive and multifaceted assessment was done in a standardised way, thereby focusing on the process of care rather than health care outcome. Following each visitation by an ad hoc visiting committee, consisting of three experienced gynecologists, the plenary visitation committee issues a formal report to the participating obstetric and gynecological centre. Apart from the condensed summary of the findings of the visiting committee during the 1 day visit, the report contains recommendations for the improvement of obstetric and gynecological care. Results: problems most commonly encountered during visits were in the areas of communication. Other problem areas frequently encountered include deficient medical record keep and lack of adherence to the standards for postgraduate education. Conclusions: given the willingness of gynecologists to participate in a constructive way and their readiness to comply with the recommendations, it is concluded that formal visiting could provide an important means of improving obstetric and gynecological care in a hospital setting.