International Accreditation Programme
Triona Fortune
Director of Programmes
8/11/2012
Why we need to improve?
One in ten adults contract infection in hospital
One in ten patients receive wrong medication or wrong dose
More deaths after experiencing adverse events in hospital than deaths from breast cancer, motor vehicle accidents and HIV combined
WHO – Fact File
Adverse Events
1.4 million HAI
1.3 million die unsafe
Developing Countries
20 times higher
Up to 70% of syringes 1.3 million die unsafe injection
Cost $6 – 29 billion
Up to 70% of syringes reused
What do we need?
Quality & Patient Safety Tools
PDCA Six Sigma
Local Departmental National
PDCA Donabedian RCA Fishbone TQM
Six Sigma Lean EFQM ISO Accreditation
Accreditation is a self-assessment and external peer review process used by health care organizations to accurately assess their level
Accreditation
organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve the health care system.
ISQua 1998
Accreditation of healthcare services is in demand in many countries:
By government, funders, patients and communities
Why the demand?
communities
They all want to know that care is SAFE
That treatment is effective
That limited resources are used efficiently
ISO vs. Accreditation
Sept 2010
Shaw et al ISQua 2010 Accreditation and ISO certification: Do they explain differences in quality management in European hospitals?
Accreditation Bodies 1951-2009
25
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October 2010 International survey results 9
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Government Mixed Independent
Shaw et al, 2010 International Survey of Accreditation Organisations 2009
Benefits of Accreditation
Still a dearth of scientific research outlining benefits but improving
Difficult to measure as variables difficult to control
25 Benefits Listed
Risk Mitigation System
Strengthens interdisciplinary team effectiveness
Improves communication
Accreditation Canada (2011)Value and impact of accreditation: a literature
review
Improves communication
Promotes measurement and use of indicators
Improvements needed
Does not increase patient satisfaction
Data capture
Research shows inconsistent findings – but accreditation does promote change and professional development
and may
“In many parts of the world, accreditation is accepted as an important element of quality improvement activities”
What does the evidence show?
and may have an organizational financial impact
improve measured quality performance
with public disclosure of outcomes, increase the credibility of the hospital with the community
There is insufficient evidence to know if accreditation improves patient satisfaction
Health Sector Accreditation Research: a systematic reviewGreenfield and Braithwaite. Int. Journal for Qual. in Healthcare.20:172 -183 2008
Clinical benefits an example Gratwohl et al (2011), Patient outcome was systematically better
when the transplantation centre was at a more advanced phase of JACIE accreditation
Lichtman et al (2011), CVA accreditation resulted in reduced mortality rate but no change in readmission ratesmortality rate but no change in readmission rates
Menachemi et al (2008), Ambulatory care centres, patients in JCI accredited facilities were significantly less likely to be re hospitalized after colonoscopy
Weeks et al (2007), Among JCAHO accredited hospitals, higher accreditation scores did not consistently discern better surgical outcomes.
Cost
Does improving quality save money: A review of research into productivity and the economics of quality improvement
unsafe care is expensive
improving clinical co-ordination saves money
CQI may reduce costs but can be limited
Øvretveit 2009. The Health Foundation.
Accrediting the Accreditors
International Accreditation Programmes (IAP)
Standard Standard
Organisation
Surveyor Training Programme
Is a
17
AccreditationIs a
processNot an event
How is a survey conducted?
Standards
Self-assessment
Accreditation
Award
A f
ou
r year
cycl
e o
f...
18
assessment
Peer Review
Full report & recommendations
Continuous Assessment
Award
A f
ou
r year
cycl
e o
f...
Organisational Accreditation
Governance Strategic, Management Risk Management
Sta
nd
ard
s
Human Resources Information Management Accreditation Award
Assessment Management
Surveyor ManagementE
igh
t S
tan
dard
s
19
Opportunities to improve
Effectiveness of the governance not evaluated -60%
ISQua Surveys 2008 -2011
20
60%
No orientation for board members -46%
Strategic plan not fully developed -40%
Risk Management Framework needs further work -55%
Principles for Standard Developemnt
Quality Improvement
Patient / Service User
Focus
Organisational Planning &
Performance
Pri
nci
ple
s
Focus Performance
Patient Safety Standards Development
Standards MeasurementS
ix P
rin
cip
les
21
IAP Awards to Date
38 organizations
84 sets of standards
16 surveyor training programmes
Setting exemplary standards
• American Association of Blood Banks - AABB
• Accreditation Canada
• The Australian Council on Healthcare Standards - ACHS
• Aged Care Standards and Accreditation Agency, Australia - ACSAA
• Australian General Practice Accreditation Limited / Quality in Practice - QIP/AGPAL
• Council for Health Service Accreditation of Southern Africa - COHSASA
• Diagnostic Accreditation Program of British Columbia, Canada - DAP
• Global-Mark Pty Ltd, Healthcare Certification Programme, Australia
Accredited Organisations
• Global-Mark Pty Ltd, Healthcare Certification Programme, Australia
• Haute Autorité de santé, France - HAS
• Health Care Accreditation Council of Jordan - HCAC
• Health and Disability Auditing Australia - HDAA
• Health and Disability Auditing New Zealand - HDANZ
• Instituto Colombiano de Normas Técnicas y Certificación- ICONTEC Columbia
• The Danish Institute for Quality and Accreditation in Healthcare - IKAS
• Joint Commission International, USA - JCI
• Malaysian Society for Quality in Health - MSQH
• Netherlands Institute for Accreditation in Healthcare - NIAZ
• Quality Improvement Council and the QIC Accreditation Program, Australia - QIC
• Taiwan Joint Commission on Healthcare Accreditation - TJCHA
• National Accreditation Board for Hospitals & Health Care Providers, India - NABH
IAP International Reach Australia Brazil Canada Columbia Croatia Czech Republic
Kazakhstan Korea Kyrgyzstan Malaysia Netherlands New Zealand Czech Republic
Denmark Dubai Egypt France Hong Kong India Indonesia Japan Jordan
New Zealand Norway Philippines Saudi Arabia South Africa Spain Taiwan Thailand United Kingdom United States
Why ISQua Accreditation
International Accreditation Programmes are varied in approach and content
ISQua accreditation helps to standardise by providingproviding current evidence based standards, self-assessment,
peer review and consistent application
all organisations despite maturity level assessed against the same standards
Patient Safety Friendly Hospital
EMRO 2008
Requires different strategies Limited capacity Limited capacity
Minimal data
Standards
PSFH Standards
Leadership and Management
Patient and Public Involvement
Safe Clinical Practices Supported by Evidence Safe Clinical Practices Supported by Evidence
Safe Environment
Lifelong Learning
CoreCriteria
C.5.1.1. The hospital‘s safe medication system coversthe following: selection and procurement, storage of medication, ordering and transcribing, preparing and dispensing, administration and follow-up.C.5.1.2. The hospital ensures legible handwriting when
PSFHThe hospital has a safe medication system
C.5.1.2. The hospital ensures legible handwriting when prescribing or writing doctors orders. C.5.1.3. The hospital ensures availability of life savingmedications at all times.C.5.1.4. The hospital ensures medicine reconciliation atadmission and dischargeC.5.1.5. The hospital ensures the patient (or carer) iseducated about medication at discharge
DevelopmentalCriteria
C.5.2.1. The hospital has process to ensure pharmacistreview of medication orders
IJQHC Conference New
Education
Fellowship
ISQua’s other activities
WHO official relations
Mission
Inspiring, promoting and supporting continuous improvement in the quality and continuous improvement in the quality and
safety of healthcare worldwide