Accreditation as a Regulatory Tool and QA: Learning from the Asia Experience

Accreditation as a Regulatory
Tool and QA:
Learning from the Asia Experience
Assoc. Prof. Jiruth Sriratanaban,
M.D., M.B.A., Ph.D.
Department of Preventive and Social Medicine
Faculty of Medicine, Chulalongkorn University
Outline
Health system needs for quality
assurance and hospital accreditation
System options for managing quality
Hospital accreditation (HA) as
regulatory incentive in Thailand
Lessons learned from Thailand HA
Roles of the Health System
Respect for patient rights
and more client orientation
World Health Report (2000)
Health
outcome
improvement
Some of major challenges for
Thailand’s health care systems
• Inequity due to mal-distribution of health resources
• Increasing health care expenditure
• Introduction of close-ended payment mechanisms by
the major health security schemes
• Expansions of business health sectors and the
governmental “Medical hub” policies
Threats against
quality of health care
Alarming information from
Adverse events studies
study
date
Rate (%)
Death
Preventable
HMPS
1984
3.7
13.6 %
-
UTCOS
1992
5.4
5.6 %
54%
QAHCS
1992
16.6
4.9 %
51%
UK
1999-2000
11.7
8.0%%
48%
Denmark
1998
9.0
-
-
Thailand(1)
2003
9.1
-
71%
System options for assuring quality
of hospital Care
System resources management (e.g., financing
reform, autonomous hospitals)
Licensure (Legal requirement for operation)
Quality audit (e.g., standards and guidelines)
Quality assurance and quality management systems
(e.g., ISO, MBNQA, etc.)
Quality improvement (e.g., TQM, CQI, Indicators
comparison, Benchmarking, etc.)
Quality assessment and accreditation
Public disclosure of information on provider quality
Proposed Conceptual framework for the Master plan
for managing quality under NHSS
(Sriratanaban, et al. 2005)
Promoting quality
1
Determination
of Quality
requirement
Hospital accreditation
Correcting quality
Promotion of 3
standards and
guidelines
Resources
Regulations
Payment
System mgt.
Information
Management
systems for
quality
Health
services
Policy and
management
decision making
2
Quality
monitoring
 Health
outcomes
 Practices
 Satisfaction
 Complaints
4
Beneficiaries empowerment
and participation
5
Hospital accreditation
as a regulatory incentive
Improve quality of health care
Patient safety and risk management
Evidence-based practice
Continuous learning and improvement
Stimulate and improve integration and
management of health services
Reduce variation in care and health
care costs
Strengthen the public’s confidence in
the quality of health care
What is
Hospital Accreditation ?
Mechanisms for recognition of institutional
competence
By an independent accrediting body (Usually)
– Participation by professional groups
Applying hospital standards for optimal and
achievable performance
Emphasis on continuous quality improvement
Hospital survey by external peer reviewers
Voluntary participation (Usually)
Examples of HA programs in Asia
• Many countries in Asia have hospital
accreditation programs, for example,
–Taiwan
–Korea
–Indonesia
–Japan
–Thailand
–Malaysia
–India (In certain states), etc.
•
•
•
•
•
Thailand
Began as a research and development project
in 1997 under the Health System Research
Institute (HSRI) with financial support from
WHO, TRF and HSRI of Thailand
Collaboration for Hospital Quality
Improvement and Accreditation
Institute for Hospital Quality Improvement
and Accreditation (HA-Thailand)
Technical support by external consultants
from Canada (Adapted Canadian approach to
HA)
35 pilot public and private hospitals
Quality improvement cycle
Plan
Do
Quality
hospital
Act
Check
CQI
Hospital
QA/
Standard
RM
Accredit
Accredit
HA standard framework
(Thailand 1999-2005)
Health needs and
customers’ expectations
Governance and policy directions
[1], [2]
Resource management
[3], [4], [5], [6], [7]
Professional systems,
patient rights and
organizational ethics
[11], [12], [13], [14],
Input
Patient care process and services
[10], [15], [16], [17], [18], [19], [20]
Analysis, measurement
and improvement
[8], [9]
Output
Patients and other customers
Health outcomes,
Satisfaction
Information and knowledge management
Part IV
Staff focus
Strategic planning
Leadership
Results
Focus on patients
And Patient rights Part I
Process
management
Health care
Patient and customer
Financial
Human resources
Organization effectiveness
Leadership and Social
Health Promotion
MBNQA/TQA Model
Key hospital systems Part II
Hospital and
Health care
services
Standards
2006
Risk, Safety and Quality
Professional management
Environmental management
Infection prevention and control
Medical record system
Medication system
Medical laboratory system
Radiological system
Work with communities
Patient care processes
Part III
Patient care processes
Entry
Patient Assessment
Planning (Care & Discharge)
Care Delivery
Patient & Family Empowerment
Continuity of Care
Institute of Hospital Quality Improvement and Accreditation, THAILAND
Accreditation Survey
• Leadership interview
• Clinical and support staff and team
interviews
• Patient and family interviews
• Observation of patient care and services
provided
• Building tour and observation of patient
care areas
• Review of written documents
• Review of patients’ medical records
• Evaluation of the organization’s
achievement of outcome measures
Accredited hospital means …






Organization commitment on quality
improvement
Adequacy of health care resources with efficient
management
Existence of quality assurance and continuous
quality improvement
Existence of mechanisms to promote
professional standards and ethics
Service provision that protects patient rights
and promotes organization ethical practices
Quality patient care processes
Potential impacts
• Health system
governance
• System design and
development
• System financing
• Population health
• Knowledge
management and
transfer
• Clinical effectiveness
• Patient empowerment
and decision-making
• Professional and
personal development
• Management
development
• Quality system
development
Number of HA-accredited and
HPH-certified hospitals
250
50
200
40
150
30
100
20
50
10
0
0
Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan04
04
04
05
05
05
05 06
06
06
06
07
Time (Month / Year)
HA
HPH
HPHA
Acc.HA
Acc.HPH
Acc.HPHA
Accumulated number
Number of new accredited or
certified hospitals
60
Purchasing quality health care…
 Social Security Scheme endorsement of HA
– Special quota of registered beneficiaries for
accredited providers
 National Health Insurance Scheme movement
– Financial support for HA consultation programs
– Financial bonus for accredited providers
 Impacts for national health service systems
– Health promoting hospital
– Use of evidence-based practice
– Disease management programs by NHSO
– Humanized health care initiatives
Lessons learned: Government roles
in supporting accreditation
 Policy endorsement
 Leverage for accredited hospitals and other
financial incentives
 Consideration in purchasing decisions
 Alignment of HA with other regulating mechanisms
 Program acknowledgement
 Program financing
 Technical support networks
 Public relations and reward systems
Lessons learned: Major barriers
to successful implementation
Unclear purpose and unrealistic expectations
Inappropriate technical approach
Failure to involve stakeholders
Lack of motivation (Provider)
Poor cooperation among professional and
governmental bodies
Under-funding and lack of governmental
commitment
Failure to learn