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Accreditation as a Regulatory Tool: Learning from Asia's Experience
- 1. Accreditation as aAccreditation as a Regulatory Tool andRegulatory Tool and QA:QA: Learning from the AsiaLearning from the Asia ExperienceExperience AssAssococ. Prof. Jiruth Sriratanaban,. Prof. Jiruth Sriratanaban, M.D., M.B.A., Ph.D.M.D., M.B.A., Ph.D. Department of Preventive and Social MedicineDepartment of Preventive and Social Medicine Faculty of Medicine, Chulalongkorn UniversityFaculty of Medicine, Chulalongkorn University
- 2. OutlineOutline Health system needs forHealth system needs for quality assurance andquality assurance and hospital accreditationhospital accreditation System options forSystem options for managing qualitymanaging quality Hospital accreditationHospital accreditation (HA) as regulatory(HA) as regulatory incentive in Thailandincentive in Thailand
- 3. Roles of the Health SystemRoles of the Health System World HealthWorld Health Respect for patient rights and more client orientation Health outcome improvement
- 4. Some of majorSome of major challenges forchallenges for Thailand’s health careThailand’s health care systemssystems• Inequity due to mal-distribution of health resourcesInequity due to mal-distribution of health resources • Increasing health care expenditureIncreasing health care expenditure • Introduction of close-ended payment mechanisms byIntroduction of close-ended payment mechanisms by the major health security schemesthe major health security schemes • Expansions of business health sectors and theExpansions of business health sectors and the governmental “Medical hub” policiesgovernmental “Medical hub” policies Threats against quality of health care
- 5. Alarming information fromAlarming information from Adverse events studiesAdverse events studies studystudy datedate Rate (%)Rate (%) DeathDeath PreventablePreventable HMPSHMPS 19841984 3.73.7 13.6 %13.6 % -- UTCOSUTCOS 19921992 5.45.4 5.6 %5.6 % 54%54% QAHCSQAHCS 19921992 16.616.6 4.9 %4.9 % 51%51% UKUK 1999-20001999-2000 11.711.7 8.0%%8.0%% 48%48% DenmarkDenmark 19981998 9.09.0 -- -- ThailandThailand(1)(1) 20020033 9.19.1 -- 71%71%
- 6. System options for assuring qualitySystem options for assuring quality of hospital Careof hospital Care System resources management (e.g., financingSystem resources management (e.g., financing reform, autonomous hospitals)reform, autonomous hospitals) Licensure (Legal requirement for operation)Licensure (Legal requirement for operation) QualityQuality audit (e.g., standards and guidelines)audit (e.g., standards and guidelines) Quality assurance and quality management systemsQuality assurance and quality management systems (e.g., ISO, MBNQA, etc.)(e.g., ISO, MBNQA, etc.) QualityQuality improvement (e.g., TQM, CQI, Indicatorsimprovement (e.g., TQM, CQI, Indicators comparison, Benchmarking, etc.)comparison, Benchmarking, etc.) Quality assessment and accreditationQuality assessment and accreditation Public disclosure of information on provider qualityPublic disclosure of information on provider quality
- 7. Proposed Conceptual framework for the MasterProposed Conceptual framework for the Master plan for managing quality under NHSSplan for managing quality under NHSS (Sriratanaban, et al. 2005)(Sriratanaban, et al. 2005) Promotin g quality Correctin g quality Determination of Quality requirement Promotion of standards and guidelines Resourc es Beneficiaries empowerment and participation Regulations Payment System mgt. Information Quality monitoring • Health outcomes • Practices • Satisfaction • Complaints Policy and management decision making Management systems for quality 2 3 4 5 Health services 1 Hospital accreditation
- 8. Hospital accreditationHospital accreditation as a regulatory incentiveas a regulatory incentive Improve quality of health careImprove quality of health care Patient safety and risk management Evidence-based practice Continuous learning and improvement Stimulate and improve integration andStimulate and improve integration and management of health servicesmanagement of health services Reduce variation in care and healthReduce variation in care and health care costscare costs Strengthen the public’s confidence inStrengthen the public’s confidence in the quality of health carethe quality of health care
- 9. What isWhat is Hospital Accreditation ?Hospital Accreditation ? Mechanisms for recognition of institutionalMechanisms for recognition of institutional competencecompetence By an independent accrediting bodyBy an independent accrediting body (Usually)(Usually) – Participation by professional groups Applying hospital standards for optimal andApplying hospital standards for optimal and achievable performanceachievable performance Emphasis on continuous qualityEmphasis on continuous quality improvementimprovement
- 10. Examples of HA programs in AsiaExamples of HA programs in Asia • Many countries in Asia haveMany countries in Asia have hospital accreditationhospital accreditation programs, forexample,programs, forexample, –TaiwanTaiwan –KoreaKorea –IndonesiaIndonesia –JapanJapan –ThailandThailand –MalaysiaMalaysia –India (In certain states),
- 11. ThailandThailand • Began as a research and developmentBegan as a research and development project in 1997 under the Health Systemproject in 1997 under the Health System Research Institute (HSRI) with financialResearch Institute (HSRI) with financial support from WHO, TRF and HSRI ofsupport from WHO, TRF and HSRI of ThailandThailand • Collaboration for Hospital QualityCollaboration for Hospital Quality Improvement and AccreditationImprovement and Accreditation • Institute for Hospital Quality ImprovementInstitute for Hospital Quality Improvement and Accreditation (HA-Thailand)and Accreditation (HA-Thailand) • Technical support by external consultantsTechnical support by external consultants from Canada (Adapted Canadian approachfrom Canada (Adapted Canadian approach to HA)to HA) 35 pilot public and private hospitals
- 13. HA standard frameworkHA standard framework (Thailand 1999-2005)(Thailand 1999-2005) Governance and policy directions [1], [2] Resource management [3], [4], [5], [6], [7] Patient care process and services [10], [15], [16], [17], [18], [19], [20] Analysis, measurement and improvement [8], [9] Patients and other customers Professional systems, patient rights and organizational ethics [11], [12], [13], [14], Input Output Health needs and customers’ expectations Health outcomes, Satisfaction
- 14. Institute of Hospital Quality Improvement and Accreditation, THAILAND Leadership Strategic planning Focus on patients And Patient rights Staff focus Process management Results Information and knowledge management Key hospital systems 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 Entry Patient Assessment Planning (Care & Discharge) Care Delivery Patient & Family Empowerment Continuity of Care Health care Patient and customer Financial Human resources Organization effectiveness Leadership and Social Health Promotion Hospital and Health care services Standards 2006 Part IV Part III Part II Part I Patient care processes MBNQA/TQA Model
- 15. Accreditation SurveyAccreditation Survey • Leadership interviewLeadership interview • Clinical and support staff and teamClinical and support staff and team interviewsinterviews • Patient and family interviewsPatient and family interviews • Observation of patient care and servicesObservation of patient care and services providedprovided • Building tour and observation of patientBuilding tour and observation of patient care areascare areas • Review of written documentsReview of written documents • Review of patients’ medical recordsReview of patients’ medical records • Evaluation of the organization’sEvaluation of the organization’s achievement of outcome measuresachievement of outcome measures
- 16. Accredited hospital means …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
- 17. Potential impactsPotential impacts • Health systemHealth system governancegovernance • System design andSystem design and developmentdevelopment • System financingSystem financing • Population healthPopulation health • KnowledgeKnowledge management andmanagement and transfertransfer • Clinical effectivenessClinical effectiveness • Patient empowermentPatient empowerment and decision-makingand decision-making • Professional andProfessional and personalpersonal developmentdevelopment • ManagementManagement developmentdevelopment • Quality systemQuality system developmentdevelopment
- 18. Numberof HA-accredited andNumberof HA-accredited and HPH-certified hospitalsHPH-certified hospitals 0 10 20 30 40 50 60 Apr- 04 Jul- 04 Oct- 04 Jan- 05 Apr- 05 Jul- 05 Oct- 05 Jan- 06 Apr- 06 Jul- 06 Oct- 06 Jan- 07 Time (Month / Year) Numberofnewaccreditedor certifiedhospitals 0 50 100 150 200 250 Accumulatednumber HA HPH HPHA Acc.HA Acc.HPH Acc.HPHA
- 19. Purchasing quality health care…Purchasing quality health care… Social Security Scheme endorsement of HASocial Security Scheme endorsement of HA – Special quota of registered beneficiaries for accredited providers National Health Insurance SchemeNational Health Insurance Scheme movementmovement – Financial support for HA consultation programs – Financial bonus for accredited providers Impacts for national health service systemsImpacts for national health service systems – Health promoting hospital – Use of evidence-based practice – Disease management programs by NHSO
- 20. Lessons learned: Government rolesLessons learned: Government roles in supporting accreditationin supporting accreditation Policy endorsementPolicy endorsement Leverage foraccredited hospitalsLeverage foraccredited hospitals and otherfinancial incentivesand otherfinancial incentives Consideration in purchasingConsideration in purchasing decisionsdecisions Alignment of HA with otherAlignment of HA with other regulating mechanismsregulating mechanisms Program acknowledgementProgram acknowledgement Program financingProgram financing
- 21. Lessons learned: Major barriersLessons learned: Major barriers to successful implementationto successful implementation Unclearpurpose and unrealisticUnclearpurpose and unrealistic expectationsexpectations Inappropriate technicalInappropriate technical approachapproach Failure to involve stakeholdersFailure to involve stakeholders Lack of motivation (Provider)Lack of motivation (Provider) Poorcooperation amongPoorcooperation among professional and governmentalprofessional and governmental bodiesbodies
Editor's Notes
- Why does a health system need quality assurance and hospital accreditation? According to the World Health Report 2000 by WHO, improving health outcome is one of the major objectives of the health system. In order to do so, service delivery or service provision and responsiveness of the system to people expectation are critical determinants. That implies quality of health care services.
- A number of studies in the U.S., as well as in UK and Denmark, worked on adverse events in hospitals. Usually, medical record review was applied. These studies identified adverse event rates ranging from 3.2 to 16.6 percent.
- Hospital accreditation has been increasingly popular among Asian countries. For instance, Taiwan in 1986 Korea and Indonesia in 1995 Japan in 1997 Thailand and Malaysia in 1999 There are also accreditation program in certain states of India.