The IMHA Quality Assurance andAccreditation Programme for Maritime Clinics Dr Sally Bell Clinical Quality Consultant IMHA Quality Executive Secretary
• Why have a Quality Assurance Programme?• Development• Implementation• Benefits• The Future
Why have a Quality Assurance Programme?Generally - Increasing relevance of QualityAssurance to modern practice worldwide.Specifically - Requirements of MLC and newlydrafted fitness standards for seafarers.The best clinics and doctors provide a highstandard of service to seafarers and themaritime sector but some clinics and doctorsdo not.
What are the problems• Lack of training or experience• Poorly maintained or inappropriate equipment• Inaccurate test results• Poor clinical decision taking• Premises unhygienic, infection control risk• Cost cutting or corruption
Consequences of poor service• Seafarers who need treatment do not get the right treatment.• Seafarers may return to sea when they are not fit to do so.• Seafarers may be unreasonably denied employment that they are capable of undertaking.• Preventative medicine may not be used to the full.• Time, money and seafaring skills are wasted.• Lack of trust in providers
Who sees the problems (if they look…)?Maritime authorities• Inconsistent fitness decisions may be taken• Unethical standards of practiceShip operators• Loss of skilled crew• Avoidable illness and safety risks at sea.Seafarers’ organisations• Denial of employment that is within a person’s capabilities• Poor care for their membersInsurers• Who end up paying the bills – but only if they are above the relevant deductible
What are the solutions?• Adoption of good practice criteria e.g. ILO/IMO guidelines on medical examinations including QA recommendations• Audit and accreditation of doctors and clinics as mark of quality for all users of the service.• Already done to varying extents by some authorities, ship operators, insurers or seafarers’ organisations but programmes are not all to the same level, and criteria may be ill defined.• More effective to have a single definitive system acceptable to all stakeholders – such as IMHA Quality
IMHA Quality or ISO?• ISO system – good standards for management – not adapted for the delivery of medical care• IMHA Quality Standards – designed to ensure high quality provision of maritime medical advice – able to interact with stakeholders 8
The process of development of Quality Assurance standards
Standards needed in a number of areas:• Medical fitness examinations – first priority• Occupational Health Advice• Port Health Clinics• Repatriation and rehabilitation• Telemedical advice.
Medical Fitness Examinations• Standards have been developed to define best practice and provide straightforward goals.• Assessment against these standards will provide the basis for accreditation and help to drive continuous quality improvement.
How did we develop them?• The standards had to be easily understood, comprehensive, and endorsed by an approved accreditation body.• We chose to work with CHKS, a London organisation specialising in healthcare accreditation worldwide.
What is covered by the standards?• Each standard addresses an area of work or activity and is made up of a number of criterion statements.• Criteria are designed to be measurable and set out what needs to be achieved.
Areas included in the standards• Clinic Management,• Staff, Clinic Facilities, Clinical Practice• Diagnostic Services• Health Records and IT• Infection Control, Health and Safety• Quality Improvement Activities296 criteria in all
Examples of standards:• STAFF: The service is managed and staffed effectively and efficiently in order to achieve its objectives.• CLINIC FACILITIES: The environment, facilities and equipment ensure safe, efficient and effective care for seafarers and staff.
Examples of specific criteria for staff:• The doctors performing seafarer examinations have occupational health qualifications, knowledge or experience.• Staff using specialised equipment are trained and competent in its use.
• The standards were reviewed and approved by the CHKS accreditation committee.• They will continue to be improved and refined at intervals in order to ensure that they continue to reflect current best practice.
Quality improvement and accreditation• Application and Self-assessment – Listed as IMHA QA member• Working towards compliance with standards – Advisor from IMHA QA• Assessment visit when ready (time limit) – Peer review• Accreditation decision – Listed as IMHA QA Accredited Clinic• Continuing quality improvement
www.imhaquality.net• Public and member information – Allows all to register an interest in the programme – All information about the programme – Information regarding those accredited, and also those working towards accreditation 21
www.imhaquality.net• The virtual office of IMHA QUALITY – Allows registration details to be entered on line – Messaging facility for communications between IMHA Quality staff and clinics – Securely store accreditation information
Accreditation committee• Endorses recommendations on accreditation• Composition – Members from Stakeholder Advisory Group – IMHA representatives• Appointment by IMHA Board
Stakeholder Advisory GroupThis group will be composed of selectedmembers of the Stakeholdercorrespondence group, and will beconsulted throughout the programme onmatters of policy and procedure.
Quality Assurance of the programme• External training for assessors• External advice from a recognised accreditation body (CHKS are UKAS accredited)• External review of assessments by outside auditors• Regular review of standards by independent advisors.
Benefits of the programme• Clinics• Maritime Authorities• Seafarers and Maritime Trade Unions• Employers, Agents, Insurers
Clinics• IMHA Quality provides a quality assured and internationally recognised system of QA• Will help to achieve quality goals• Potential clients will be aware of commitment to quality• Can demonstrate by accreditation that they can provide valid and fair seafarer assessment• Accreditation will assist in achieving approval from other bodies, whether maritime authorities, shipowners or P & I Clubs.
Maritime Authorities• ensure procedures comply with STCW and MLC• meet the recommendations of the ILO/IMO International Guidelines to provide a QA system for seafarer medical examinations• does not interfere with discretion to set national standards but will confirm that these are being correctly applied.• assist with mutual recognition of medical certificates• help authorities to decide which providers to approve (particularly internationally)
Seafarers, Trade Unions• Reduce concerns about justification or fairness of seafarer fitness decisions.• Ensure fair conduct of medicals (as per the ILO/IMO Guidelines on Seafarer Medical Examinations )• Ensure commitment to sound ethical standards• Ensure seafarers provided with full information about reasons for fitness decisions,• Ensure referral if a new illness is found• Maintain confidentiality of medical information.• Ensure that only seafarers who cannot work safely or effectively or who may have their health endangered by doing so are prevented from working.
Employers, Agents, Insurers• Ensure seafarers can work safely and effectively• Reduce risk of requiring evacuation, treatment or repatriation.• Ensure providers are committed to following the detail of decision-taking requirements whether national or in house.• Reduce costs of in house clinic assessment or audit• Minimise the inefficiency of multiple assessments of the same provider by different users.• Ensure providers are fit for purpose and acceptable to seafarers, maritime authorities and other groups
The Future• Later phases of the programme will develop standards for other services: – Occupational Health Advice – Port Health Clinics – Repatriation and rehabilitation – Telemedical advice.• This should involve only a small increment in development work and costs.
Contact• General inquiries – firstname.lastname@example.org• Manager – email@example.com• Executive committee members – firstname.lastname@example.org – email@example.com• Supervisor – firstname.lastname@example.org