Nationwide implementation of the electronic sick leave certificates in Poland: quality improvement initiative towards value-based primary care resulting in rapid implementation in integrated care

Introduction: Electronic sick leave certificates, called e-ZLA, were being implemented nationwide in Poland from 1 January 1 2016 until 30 November 30 2018. During the time of implementation doctors in Poland could issue sick leave certificates alternatively in electronic or in the paper form. Since 1 December  2018 sick leave certificates are to be issued in the whole Poland electronically only.

Practice change: Paper form certificates in Medical and Diagnostic Centre (CMD) – an integrated care organization located in Siedlce (Poland) used to be prepared with the help of the registration or nurse staff. The average work time consumed for that process was calculated in CMD for 13 minutes per one paper form certificate. CMD is serving approximately 85000 patients and issues about 1500 sick leaves certificates every month. Therefore, CMD made an effort of rapid implementation of electronic sick leave certificates issuing.

Aim and theory of change: The vendor of computer application for managing of health care related processes introduced in February 2018 in CMD’s client application a new functionality of issuing electronic sick leave certificates. The personnel of CMD was trained adequately.

Timeline: The first e-ZLA in the CMD was issued on 20February 2018. After short period of time when the correctness of sickleaves certificates issued via client application was being verified, the change was implemented in the whole organization.

Highlights: The concept of having an e-certificate uploaded and stored within the system was highly appreciated by CMD staff. The average time of e-ZLA issuing and its online transmission is 2-3 min compared to 13 min for managing paper-form sick leave certificates. Between 20 February 2018 and 30 November 2018, CMD doctors used to issue about 1200 e-ZLAs monthly. The necessity of writing multiple sick leave certificates for patients having more than one employer was also eliminated. This system allows also for review the history of e-ZLAs received by the patient and thus prevent potential abuses.

Conclusions: As a result of e-ZLA introduction, the registration staff and nurses were relieved from paper work related to issuing paper-form certificates and additional administrative tasks related to providing copies of sick leave certificates to health insurer branches. Decrease of paper work burden resulted in saving of time which could be sacrificed for patients. Enabling the release of electronic sick leave certificates was an important milestone on the way to better integrated care.