How to improve the quality of healthcare by a third-party

Transcription

1 How to imrove the uality of healthcare by a third-arty Patientfriendly & Smarter Healthcare

2 ISQua Not for Profit Membershi Organisation. Mission is to insire and drive imrovement in the uality and safety of healthcare worldwide through education and knowledge sharing, external evaluation, suorting health systems, and connecting eole through global networks.

3 The ISQua Network system Board Education Fellowshi International Accreditation Programme Partnershi with Patients Membershi Conference & Events Communities of Practice Exerts QI Network Innovations and Systems Change Grou

4 External evaluation network

5 IAP Global Presence 66 Organisations in 34 different countries

6 What is accreditation? Accreditation is a self-assessment and external eer review rocess And Aim is to accurately assess levels of erformance in relation to established standards To imlement ways to continuously imrove the health care system.

7 Guidelines and Standards for External Evaluation Organisations 4 th Edition, Standards Governance Strategic, oerational and financial management Risk management and erformance Human resources management Information management Surveyor management Survey and client management Accreditation or certification awards

8 IAP international reach Argentina Australia Brazil Canada Columbia Croatia Czech Reublic Denmark Dubai Egyt France Hong Kong India Indonesia Ireland Jaan Jordan Kazakhstan Korea Kyrgyzstan Lebanon Malaysia Netherlands New Zealand Norway Philiines Saudi Arabia Slovenia South Africa Sain Taiwan Tajikistan Thailand Turkey UAE United Kingdom United States

9 ISQua Accredited Organisations Haute Autorité de Santé DAQSS CHKS Accreditation Unit, UK Accreditation Canada Canadian Accreditation Council of Human Services - CAC Joint Commission of Taiwan JCT Council for Health Service Accreditation of Southern Africa - COHSASA Global-Mark Pty Ltd, Australia Health and Disability Auditing New Zealand - HDANZ Danish Institute for Quality and Accreditation in Health Care - IKAS Diagnostic Accreditation Programme, British Columbia Health and Disability Auditing Australia Pty Ltd - HDAA Joint Commission International - JCI Malaysian Society for Quality in Health - MSQH Australian Aged Care Quality Agency - AACQA The Healthcare Accreditation Institute (Public Organization), Thailand - HAI Australian General Practice Accreditation Ltd / Quality in Practice Pty Ltd AGPAL/QIP Quality Imrovement Council, Australia - QIC Jaan Council for Quality Health Care - JCQHC National Accreditation Board for Hositals & Health Care Providers, India - NABH DAA Grou Limited, New Zealand The Australian Council on Health Care Standards - ACHS Health Care Accreditation Council, Jordan - HCAC AABB, USA Netherlands Institute for Accreditation in Healthcare - NIAZ ICONTEC Health Accreditation Service, Columbia DNV GL Business Assurance, Norway Associacao Brasileira de Acreditacao De Sistemas e Servicos de Saude, Brazil CBA KARS Komisi Akreditasi Rumah Sakit

10 Vote 1 Do you articiate in Accreditation or External Evaluation of uality in your organisation?

11 What is accreditation? Accreditation is a self-assessment and external eer review rocess And Aim is to accurately assess levels of erformance in relation to established standards To imlement ways to continuously imrove the health care system. ISQua 1998

12 Standards Decide to imrove Develo imrovement rogram Continual imrovement

13 Vote 2 Do you think external evaluation is or would be of any value to your organization?

14 Accreditation reuires a framework and a cultural shift to be of value

15 Framework for uality to suort accreditation Quality lanning Quality imrovement Quality control Quality management Based on Juran

16 Set the standard Imrove Measure whether the standard is met

17 Work as usual will not work New ways of thinking (Deming) A change in culture Active changes We need different ways to solve the roblems Change language and the way we act, behave, learn and teach Actively adot new ways to solve challenges Slide concet based on IHI White Paer

18 Accreditation Bodies Government Mixed Indeendent October 2010 Shaw International et al, 2010 survey International results Survey of Accreditation Organisations

19 The Accreditation bodies While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to comlement mechanisms of regulation, health-care funding or governmental commitment to uality and health-care imrovement that offer a suortive environment. Princial challenges include unstable business (e.g. limited market, low utake) and unstable olitics. Profiling health-care accreditation organizations: an international survey Shaw C et al International Journal for Quality in Health Care 2013; Volume 25, Number 3:

20 Recent trends Unannounced surveys no rigorous emirical evidence to suort these surveys resumed benefits Patient satisfaction surveys reuiring atient satisfaction surveys as art of accreditation rocess. Mandatory accreditation Australia National Safety and Quality Health Service (NSQS) Standards hositals, day rocedure centres and ublic dental services Canada Mandatory in Quebec and Alberta

21 Accreditation Quality and safety structures and rocedures are more evident in hositals which are accredited or ISO certified Some differences exist between accredited versus certified hositals Interretation of these results is limited by samle size and variation Shaw et al, ISQua Accreditation and ISO certification: Do they exlain differences in uality management in Euroean hositals? Set 2010

22 Issues with standards Standards are ubiuitous within healthcare and are generally considered to be an imortant means by which to imrove clinical ractice and organisational erformance. However, there is a lack of robust emirical evidence examining the develoment, writing, imlementation and imacts of healthcare accreditation standards. The standard of healthcare accreditation standards: a review of emirical research underinning their develoment and imact Greenfield et al. BMC Health Services Research 2012, 12:329

23 Vote 3 Do you think the current standards reflect the true state of your services?

24 Systematic review 1 Accreditation romotes change and rofessional develoment has an organizational financial imact imroves measured uality erformance With ublic disclosure of outcomes, increases the credibility of the hosital with the community There is insufficient evidence to know if accreditation imroves atient satisfaction Greenfield and Braithwaite, Health Sector Accreditation Research: a systematic review Greenfield and Braithwaite. Int. Journal for Qual. in Healthcare.

25 Accreditation rograms Systematic review 2 Imrove the rocess of care rovided by healthcare services. Imrove clinical outcomes of a wide sectrum of clinical conditions. Should be suorted as a tool to imrove the uality of healthcare services. Imact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature Abdullah Alkhenizan and Charles Shaw

26 Reliability The twin lessons learnt are that a consistent survey outcome is likely to be reached when reliability of rocess and consistent alication of standards are ursued, and research reuires negotiating challengesand relationshis Researching the reliability of accreditation survey teams: lessons learnt when things went awry David Greenfield, Marjorie Pawsey, Justine Naylor and Jeffrey Braithwaite Health Information Management Journal Vol 42 no ISSn (PrInt) ISSn (online)

27 Cost benefit of accreditation This has not been studied well and the cost benefits are not well determined. Health services accreditation: what is the evidence that the benefits justify the costs? Mumford V et al International Journal for Quality in Health Care 2013; Volume 25, Number 5:

28 Vote 4 Do you think there can be cost benefits associated with Accreditation?

29 Cochrane review The review highlights the aucity of high-uality controlled evaluations of the effectiveness and the cost-effectiveness of external insection systems. If olicy makers wish to understand the effectiveness of this tye of intervention better, there needs to be further studies across a range of settings and contexts and studies reorting outcomes imortant to atients. The Cochrane Library Gerd Flodgren Daniela C Gonc alves-bradley, Marie-Pascale Pomey External insection of comliance with standards for imroved healthcare outcomes 2 December 2016

30 Canada 2011 (Udated 2015) 30 Benefits Listed Risk Mitigation System Strengthens interdiscilinary team effectiveness Imroves communication Promotes measurement and use of indicators Imrovements needed Does not increase atient satisfaction Data cature Accreditation Canada, Value and imact of accreditation: a literature review.

31 Canada Does accreditation stimulate change? We conclude that the accreditation rocess is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest greatly to conform to the first accreditation visit and rea the greatest benefits in the next three accreditation cycles (3 to 10 years after initial accreditation). After 10 years, however, institutions begin to find accreditation less challenging. To maximize the benefits of the accreditation rocess, HCOs and accrediting bodies must seek ways to take full advantage of each stage of the accreditation rocess over time. Does accreditation stimulate change? A study of the imact of the accreditation rocess on Canadian healthcare organizations Marie-Pascale Pomey*1, Louise Lemieux-Charles 2, François Chamagne 1, Doug Angus 3, Abdo Shabah 4 and André-Pierre Contandriooulos 1 Imlementation Science 2010, 5:31

32 Brazil Imact of accreditation The study identified 13 organizational imacts of accreditation. There was evidence of a significant and moderate correlation between the status of accreditation and atient safety activities, uality management activities, lanning activities olicies and strategies, and involvement of rofessionals in the uality rograms. The correlation between accreditation status and atient involvement was significant but weak, suggesting that this issue should be treated with a secific olicy. The imact of accreditation on the financial results was not confirmed as relevant; however, the need for investment in the lanning stage was validated. The imact of accreditation is mainly related to internal rocesses, culture, training, institutional image and cometitive differentiation Evaluating the imact of accreditation on Brazilian healthcare organizations: A uantitative study Ana Maria Saut, Fernando Tobal Berssaneti, Maria Carolina Moreno International Journal for Quality in Health Care,

33 Lebanon According to Lebanese nurses, hosital accreditation is a good tool for imroving uality of care. In order to ensure that accreditation brings effective uality imrovement ractices, there is a need to assess uality based on atient outcome indicators. The imact of hosital accreditation on uality of care: ercetion of Lebanese nurses. Fadi El Jadal et al International Journal for Quality in Health Care 2008; Volume 20, Number 5:

34 South Africa Ten of these hositals entered the accreditation rogram in 1998; the other ten, which served as a control, entered about two years later. The study rosectively measured the effects of the COHSASA hosital accreditation rogram on various indicators of hosital care. The imrovement of the intervention hositals relative to the controls was statistically significant and seems likely to have been due to the accreditation rogram. With the excetion of nurse ercetions of clinical uality, the indeendent research team observed little or no effect of the intervention on the eight uality indicators. The ractical imlications of the results of this study are: the COHSASA-facilitated accreditation rogram was successful in increasing ublic hositals' comliance with COHSASA standards, additional work is needed to determine if imrovements in COHSASA structure and rocess standards result in imroved outcomes. (author's) The imact of accreditation on the uality of hosital care: KwaZulu-Natal rovince, Reublic of South Africa. Author: Salmon JW; Heavens J; Lombard C; Tavrow P

35 Clinical benefits an examle Gratwohl et al (2011), Patient outcome was systematically better when the translantation centre was at a more advanced hase of JACIE accreditation Lichtman et al (2011), CVA accreditation resulted in reduced mortality rate but no change in readmission rates Menachemi et al (2008), Ambulatory care centres, atients in JCI accredited facilities were significantly less likely to be re hositalized after colonoscoy

36 Critical factors Collaborative, valid and uses relevant standards Favourably received by health rofessionals Healthcare organisations are caable of embracing accreditation Aroriately aligned with other regulatory initiatives and suorted by relevant incentives. Stakeholder ersectives on imlementing accreditation rograms: a ualitative study of enabling factors Hinchcliff et al. BMC Health Services Research 2013, 13:437

37 The need for evidence The challenge for accreditation agencies is to ublish their research rotocols and then their findings, both ositive and negative, in the eer-reviewed literature. When they do ublish their results the agencies will be exlicitly dislaying leadershi, transarency and evidence of imrovement, the very ualities and conduct they reuire of the health organisations they accredit. Develoing the evidence base for accreditation of healthcare organisations: a call for transarency and innovation David Greenfield, Jeffrey Braithwaite Qual Saf Health Care 2009;18:

38 Leverage of accreditation Providing high uality and safe atient care is a challenge in the current raidly changing and comlex health care environment. A variety of indeendent tools and methodologies can be used regulatory reuirements, uality imrovement tools accreditation methodologies. Each alone will not achieve the tiing oint in health care uality that is reuired. Accreditation can be the stimulus to align the imrovement with outcomes. Leveraging the full value and imact of accreditation Wendy Nicklin, Triona Fortune, Paul van Ostenberg, Elaine O'Connor, Nicola McCauley International Journal for Quality in Health Care, Volume 29, Issue 2, 1 Aril 2017, Pages

39 Vote 5 Would you now consider an external evaluation or accreditation rogramme for your organization?

40 Conclusion Accreditation can be a useful tool to imrove uality It needs to be art of a Quality Imrovement strategy It reuires a cultural shift by an organisation It should reach for standards above the minimum standards of insection

41 Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it reresents the wise choice of many alternatives. William Foster

42 eterlachman