Home > Guide to implementing quality standards in drug demand reduction.

Dillon, Lucy (2022) Guide to implementing quality standards in drug demand reduction. Drugnet Ireland, Issue 80, Winter 2022, pp. 31-32.

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In September 2021, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a manual offering practical advice to professionals implementing quality assurance in the area of drug demand reduction, entitled Implementing quality standards for drug services and systems: a six-step guide to support quality assurance.1 The manual provides an overview of quality standards and how they fit within the broader area of quality assurance processes, as well as a six-step guide for those planning to implement them as part of a quality assurance project.

Quality assurance and quality standards

Quality standards are one of a suite of activities for implementing quality assurance. Definitions are provided on page 5 of the manual.1

Quality assurance is a process which involves continuous monitoring and striving to improve quality and outcomes. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; design of activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.

Quality standards are one of the tools used in the quality assurance process. Based on the WHO [World Health Organization] definition, quality assurance systems in drug demand reduction focus on the extent to which drug-related interventions, services or systems improve outcomes. Quality standards are principles and sets of rules, often set by recognised national or international bodies, that may be used to implement interventions. A quality standard may be described as a statement of expected requirements. It can refer to content issues, processes or to structural aspects. Typically, the standards proposed in the health field are evidence-based, and provide clear and aspirational, yet measurable, statements related to content, processes or structural aspects of quality assurance, such as environment and staffing composition.

Strategic context

Since 2013, developing and implementing quality standards has been an explicit priority for the European Union (EU) as reflected in its drug strategies and action plans.2,3,4,5 Under strategic priority 6 of the current EU Action Plan (to ensure access to and strengthen treatment and care services), there is an action to ‘continue and further develop the implementation of the EU minimum quality standards adopted by the Council in 20154 and evidence-based guidelines in national guidelines and programmes’ (Action 38, p. 13).5 In response to this action, the EMCDDA published the current manual.

Aim of the manual

While the manual is primarily targeted at those responsible for commissioning, planning, or providing quality assurance processes, the authors argue that it may also be of interest to other stakeholders, such as service users or advocacy groups. Its overall aim is ‘to provide a practical introduction to the area of quality standards and quality assurance mechanisms and the key steps involved in their implementation in drug services and systems’ (p. 3). In doing so, the manual is not prescriptive. It highlights that there is no single correct way to implement quality assurance processes, rather those implementing the process need to consider a variety of factors to identify the best approach to meet their needs. It also recognises the wide range of quality standards available. Some may be general standards that cover all aspects of a national health or education system, while others relate specifically to drug-related services. They also vary from those developed at international, national, and local levels.

The six steps

The manual identifies six steps which outline a full cycle for stakeholders to consider when implementing quality assurance processes and standards. The authors acknowledge the need to take a flexible approach to these steps, recognising that steps will vary in their level of importance depending on the type of assessment being carried out and its focus. The six steps and some of the questions that need to be asked at each stage are as follows.

  1. Diagnosis: What is the problem the quality assurance project will address?
  2. Scoping: What are the goals and who to involve? Who needs to lead the project and who are the key stakeholders? What resources are required to deliver the project?
  3. Mapping and selection: What standards apply and how can they be verified? Which are the most appropriate quality standards to use given the circumstances?
  4. Assessing systems and services: How to evaluate whether the systems or services meet the standards being applied or do they need to be improved? What data are required to make this assessment and how will they be verified?
  5. Drafting an improvement plan and disseminating results: When, where and to whom to communicate? How can the recommendations of the report be discussed with key stakeholders?
  6. Preparing for the next cycle: How can it be ensured that a continuous cycle of evaluation is in place?

Concluding comment

The aim of quality assurance processes and the associated implementation of quality standards is to improve the quality of services provided and the outcomes achieved. This in turn supports a system in which the best value for money is achieved for all stakeholders. When discussing the manual, EMCDDA director Alexis Goosdeel outlined the benefits of quality assurance.

Quality assurance mechanisms can help professionals work better and improve services for patients, clients, staff and communities, also encouraging user involvement, transparency and accountability. Good quality drug demand reduction interventions, based on evidence and firmly located in human rights, can help improve people’s lives and life chances. At a time when there is more need than ever to ensure continuity in the financing of drug services, well-documented evidence of the quality and evaluation of these services is a must.6 

1  European Monitoring Centre for Drugs and Drug Addiction (2021) Implementing quality standards for drug services and systems: a six-step guide to support quality assurance. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/34895/

2  Council of the European Union (2012) EU drugs strategy (2013–2020). Brussels: Council of the European Union. https://www.drugsandalcohol.ie/19034/

3  Council of the European Union (2015) Council conclusions on the implementation of the EU Action Plan on Drugs 2013–2016 regarding minimum quality standards in drug demand reduction in the European Union, 11985/15. Brussels: Council of the European Union. https://www.drugsandalcohol.ie/24317/

4  Council of the European Union (2020) EU drugs strategy 2021–2025. Brussels: Council of the European Union.

5  Council of the European Union (2021) EU drugs action plan 2021–2025. Brussels: Council of the European Union. https://www.drugsandalcohol.ie/34446/

6  European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2021) Six steps to improve the quality of drug services and systems – EMCDDA launches new practical manual for decision-makers [Press release]. Lisbon: EMCDDA. Available online at: https://www.emcdda.europa.eu/news/2021/six-steps-improve-quality-drug-services-and-systems_en

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