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How Hospital Accreditation How Hospital Accreditation facilitates health care quality and facilitates health care quality and
patient safetypatient safety
Healthcare Quality Improvement and Patient Safety Forum 12-13 Dec 2008
Kaohsiung, Taiwan
Dr Paul Chang, MBBS, MPH, CPHQDr Paul Chang, MBBS, MPH, CPHQManaging Director, Asia PacificManaging Director, Asia PacificJoint Commission InternationalJoint Commission International
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Organizational Base
– Joint Commission International (JCI) is the international arm of The Joint Commission (TJC).
– Established 1997
– TJC and JCI are independent, non-profit, non- governmental agencies
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Mission of Joint Commission International
– To improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services
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International Accreditation and Certification Programs
– Hospitals (1999) – 3rd Edition (2007)
– Laboratories (2002) *– Medical Transport (2002) – Care Continuum (2003)
– Ambulatory Care (2005) *– Disease Condition-Specific Certification (2005) *– Primary Care (July 2008)
* To be revised in 200* To be revised in 20099
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Bermuda
Brazil
Mexico
Barbados
Chile
Costa Rica
Pakistan
India
Thailand
Singapore
Philippines
China
Hong Kong
Taiwan
S. Korea
Bangladesh
Indonesia
Malaysia
Turkey
Egypt
Ethiopia
Saudi Arabia
QatarUAE
JordanLebanon
Spain
Ireland
Demark
Germany
Cz. R.
Aus
Italy
Swz.
JCI HeadquartersChicago, USA
JCI European OfficeFerney-Voltaire, France
JCI Middle East OfficeDubai, UAE
JCI Asia-Pacific OfficeSingapore
JCI Accredited Organizations
To date, more than 200 in 28 countries
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Accredited Organizations in Asia-Pacific Region
22
11
11
11
22
1313
44
11
11
11 33
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– Usually a voluntary process by which a government or non-government agency grants recognition to health care institutions which meet certain standards that require continuous improvement in structures, processes, and outcomes.
Accreditation – A Definition
– Usually a voluntary process– Usually a voluntary process by which a government or non-government agency grants recognition to health care institutions
– Usually a voluntary process by which a government or non-government agency grants recognition to health care institutions which meet certain standards
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– Accreditation is often confused with:
– LicensureLicensure-governmental activity that sets minimum standards to protect the public
– CertificationCertification- evaluates special capability or unique skills/ability
Accreditation – A Definition
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Need for Accreditation
In 1918, the American College of Surgeons described the need for standardization of hospitals through accreditation as the need to:
“Encourage those which are doing the best work, and to stimulate those of inferior standard to do better.”
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– That an organization is doing the right things and doing them well;
– Thereby significantly reducing the risk of harm in the delivery of care; and
– Optimizing the likelihood of good outcomes.
Accreditation Represents a Risk Reduction Strategy
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How safe is healthcareHow safe is healthcare??
Dangerous(>1/1000)
Risky Safe(<1/100K)
Healthcare
Mountain climbing
Bungee jumping
Driving
Chemical industry
Charter flights
Regular air transport
European railways
Nuclear power
Contacts / 1 death
De
ath
s / y
ea
r
1
100,000
1000
100
10
10,000
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“Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous.”
Sir Cyril Chantler, former Dean Guy’s, King and St. Thomas’s Medical and Dental School, Lancet 1999
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– The U.S., Canada, and Australia have the oldest accreditation systems
– In Europe, Germany, France, Ireland and Spain have new accreditation systems
– In Japan, Korea, Malaysia, and Thailand there are new systems with government role
– The WHO, World Bank and development banks recognize and endorse the accreditation model
Accreditation - A World Trend
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Potential Returns on Accreditation
– Improved care – fewer complications
– Better reputation -- increased number of new patients
– More satisfied staff – better retention and lower recruitment and training costs
– More efficient, cost effective work processes
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Potential Returns on Accreditation
– Better preventive maintenance program – longer life of biomedical equipment
– Special recognition from payment sources and insurance companies
– Greater clarity to leadership structure and quality oversight
– Better safety management, and risk reduction – reduced liability
exposure
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Questions to Ask– How does accreditation lead to enhancement of patient and staff safety?
– Is it a result of compliance of standards?
– Or is it a function of the survey methodology?
– Do you have the data to prove what you are telling us?
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Joint Commission International Standards
– Set optimum, achievable expectations
– Focus on the patient– Designed to be
interpreted/surveyed within the local culture and legal framework
– Stimulates continuous improvement
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Diverse Sources of Input for Standards
– Scientific literature– Research findings– Survey compliance data– Input from field experts and key
stakeholders– Regional Advisory Councils– JCI staff and surveyors
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Rigorous Review and Approval Process
– Consensus of the Standards Subcommittee (12 members)
– Review by individual experts or expert panels
– Focus groups on select areas– Internet review by as many international
users as possible– Final approval by Accreditation
Committee and the Board of JCI
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Questions to Ask– How does accreditation lead to enhancement of patient and staff safety?
– Is it a result of compliance of standards?
– Or is it a function of the survey methodology?
– Do you have the data to prove what you are telling us?
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The JCI Evaluation Process
– Covers all portions of an organization and all systems of care and management
– Is focused on what happens to patients – patient tracers used
– Is proactive – evaluates the likely quality and safety of patient care in the future
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Tracer Methodology
Tracers provide the methodology to assess an organization’s systems and
processes by; – Following the treatment path an individual
patient has taken in the hospital, or– Following a process in the hospital from a
beginning to an endpoint. – It is about areas for improvement
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The Transparent JCI Process
International Standards
On-siteEvaluation of
Standards
Accreditation Decision
Rules
Accreditation Certificate
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El Dorado, Republic of Freedonia
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SHANGRI-LA HOSPITAL
El Dorado, Republic of Freedonia
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Questions to Ask– How does accreditation lead to enhancement of patient and staff safety?
– Is it a result of compliance of standards?
– Or is it a function of the survey methodology?
– Do you have the data to prove what you are telling us?
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Medication error rate at Indraprasthra Apollo Hospital, Delhi, India
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
Jan Feb Mar Aprl May Jun July Aug Sep Oct Nov Dec
05 06 UCL CR
Decreases in Medication Errors
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Reduction of Complications at American Hospital, Dubai, UAE
–During preparation for re-accreditation:– Emphasis on prevention of hospital associated
infections– New Clinical guidelines introduced
0
2
4
6
8
10
12
VAP UTI BSI Post-C/SInfx (%)
2005
2006
N/1
00 d
evic
e da
ys
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Reduction of Ventilator-Associated Pneumonia at
Moving Average - VAP - Year 2005
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
J an-05 Feb-05 Mar-05 Apr-05 May-05 J un-05 J ul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05
Month
Rat
e/10
00 v
entil
ator
day
s
QIP
ON
VA
P R
EDU
CTI
ON
CO
MPL
ETED
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Incidence of VAP in MSICU - 2000 to Q2 05
25.9
19.617.44
9.129.878.448.82
7.047.62
12.1
9.669.36
6.13
3.194.81
2.63.86
4.874.264.58
0
5
10
15
20
25
30
Per
thou
sand
ven
tilat
or d
ays
Target ________ NNIS ------------
Reduction in VAP Rates – National University Hospital,
Singapore
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Reduction of Complications at “Istituto Giannina Gaslini” NI/PICU
27.2
4.92.6
0
3.60.9
0
5
10
15
20
25
30
2006 2007
*
**
***
* Mortality (%) from hosp acq. Infections** Hosp acq. Infections (per 1000 pt days)*** Hosp acq. Pneumonia (per 1000 pt days)
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Improved Patient Safety
Patient Incidents per 100 Discharges
0
0.5
1
1.5
2
2.5
Jan
FebM
ar AprM
ay Jun
Jul
AugSep O
ctNov Dec
20052006
Indraprastha Apollo Hospital, New Delhi, India
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Unscheduled Returns to ICU Rates (Q1 2002 to Q4 2004) in National University Hospital, SingaporeComparison With Project-Wide & S'pore Public Hospital Rates
7.95
6.635.67
4.094.63 4.77
4.26
5.61 5.354.68
4.054.54
3.82
3.11
8.09
10.34
7.618.01
4.35
1.47 1.88
3.663.47 3.663.643.50 3.443.39 3.47 3.65 3.57 3.80 3.41
3.99 3.684.23
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Q102 Q202 Q302 Q402 Q103 Q203 Q303 Q403 Q104 Q204 Q304 Q404
NUH S'pore Public Hospitals Project-Wide
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Handwashing – Pt Safety
Trend on Hand Hygiene Compliace Rate in ICUs
77
95 95
68.1
74
40.84
30.26
20.34
45.47
6764.12
63.22
95
0
20
40
60
80
100
% C
om
plia
nc
e R
ate
Compliance 20.34 30.26 45.47 40.84 63.22 64.12 67 74 68.1 77
JCAHO Benchmark 95 95 95 95 95 95 95 95 95 95
38935 38966 38996 39027 39057 39089 39120 39148 39179 39209
JCAHO Benchmark
DesiredOutcome
n=100 n=100 n=250 n=250 n=250 n=250 n=250 n=400 n=400 n=400n = No. of Observations
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Patient Falls (%)
0
5
10
15
20
25
30
35
40
45
2004 2005 2006 2007
Apollo Hospitalstouching lives
INDIA
Indraprastha Apollo Hospital, New Delhi, India
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Needlestick Injuries – Needlestick Injuries – Changi General Hospital, SingaporeChangi General Hospital, Singapore
No. of Needlestick Injury per 1000 CGH Healthcare Workers
0.53
2.80
1.72
0.59
0.001.20
1.17
2.922.88
1.74
2.29
2.85
2.36
5.93
1.192.982.39
2.99
2.36
2.45
3.45
4.80
2.97
5.96
4.29
6.13
6.25
2.48
1.871.88
0
2
4
6
8
Ra
te o
f N
ee
dle
sti
ck
In
jury
(CGH) No. of needlestick injury per 1000 CGH healthcare workers
The rate of needlestick injuries per 1000 healthcare workers was reduced from 7.91 in 2003 to 3.48 in 1st 6 months of 2005, an
improvement of 127%
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So Far So Good
– These are individual reports, dealing with segments of hospital operations – Anecdotal accounts
– To study it systematically, – One ME hospital embarked on a study of
the effect of the process, not of the outcome, before and after JCI accreditation
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Study Details
– 400 bed Government Hospital in ME– Accredited in 2007 – Studied before start of project to comply with
JCI standards– Repeat study 15 months later (before survey)– Perceptions of stakeholders studied by
questionnaires– 100 point indices
Hassan, DK & Kanji, GK: Measuring Quality Performance in Healthcare 2007. Kingsham Press, Chichester, UK
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Findings of Study
– All stakeholder groups reported improvement in every dimension measured
– Overall improvement: 49% over baseline
Main Areas of ImprovementLeadership & managementQuality improvementPatient safetyPt satisfaction & “delight”Ethical performanceDocumentationOrganizational learningOrganizational excellence
Areas of Lesser ImprovementCorporate structureHuman resources managementStaff satisfaction
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Accreditation:Does it Make a Difference? – Joint Commission International has
conducted descriptive research with a sample of accredited hospitals to determine the value of accreditation
– Accredited hospitals report significant improvements in:– Leadership– Medical records management– Infection control– Reduction in medication errors – Staff training and professional credentialing– Improved quality monitoring
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Dear Dr. Paul, I was meeting with Dr. Chatree yesterday and he wanted me to share with you what we have just discovered about the Disease Specific Process. Even though we have not completed the process of Disease Specific certification the programs have been in place for months as we adjust and improve the pathways. Dr. Chatree presides over the monthly meeting to review the CSI report (Customer Satisfaction Index). As you know our CSI scores are quite high, however this month there was a significant and remarkable jump in the scores of the sections affiliated with the pathways - stroke, heart, and cancer. No one would have predicted it this soon and no one expected it. But the results told the story.
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Other benefits
– Recognition by Payers, Governmental Agencies and Vendors
– Marketing tool
– Increased patient volumes
– Increased organizational efficiencies
– Decreased wastage
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Conclusion– JCI accreditation assists organizations in
enhancing quality and safety in their organization through:– Internationally accepted, maximum achievable
standards that are regularly reviewed– Transparent, objective survey methodology that
emphasises frontline, on-the-ground practices for demonstrating compliance
– Focus on fostering a culture of leadership, accountability and drive for continuous improvement that will support sustained improvements in the organization.
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Grazie.Grazie.
Xie Xie Xie Xie
Do jeh
Arigato
ShukraShukra
nn
Komawoyo
Tak tesekkür ederim
