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