Quality Improvement of Medical Units: International Healthcare Accreditation

Transcription

1 Quality Improvement of Medical Units: International Healthcare Accreditation 黃仲毅副執行長財團法人醫院評鑑暨醫療品質策進會 Taiwan Joint Commission on Hospital Accreditation 1

2 Reasons medical tourists go abroad: Real or perceived lack of services at home Limitations imposed by payors or regulatory agencies, certain specialists and/or procedures Treatment protocols, equipment, or services Prolonged waiting periods Lower costs of care Personal reasons 2

3 Characteristics of Medical Tourists Quality-sensitive medical tourists: Affluent people e.g. wealthy citizens Ruling elites e.g. Myanmar army Generals seeking medical care in more developed SEAsian countries Price-sensitive medical tourists: Middle class people who are reasonably wellinformed about foreign countries and which foreign medical centers to go to Kai-Lit Phua 3

4 Kinds of Medical Treatment Likely to be Sought Overseas 1. Quality-sensitive medical tourism: sophisticated services e.g. open heart surgery 2. Price-sensitive medical tourism: Non-urgent medical procedures such as hip replacement or knee replacement surgery, cosmetic surgery, dental surgery, gender reassignment surgery Other possibilities: organ transplants ( transplant tourism ) Kai-Lit Phua 4

5 Criteria for Selecting Hospital 5 5 Reputation for quality Indicated experience in selected procedures Accreditation status Ability to provide clinical data Agreement to participate in our quality assurance and reporting program Customer service orientation Excellent nurse to patient ratio Choice of geographic location Familiarity with the needs of international patients International standards in clinical delivery and patients rooms World-class medical infrastructure and equipment

6 Other Considerations Complementary and alternative medicine Non FDA-approved treatments/procedures/medications Clinical trials Treatment of minors Efficacy of stem cell treatment Ethics 6

7 How can the quality of healthcare services be assured? Accreditation is a way. 7

8 Definition of Accreditation Accreditation has been defined as "A selfassessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve" 8

9 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) 9

10 Four principal components: It is based on written and published standards Reviews are conducted by professional peers The accreditation process is administered by an independent body The aim of accreditation is to encourage organizational development. 10

11 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 11

12 Patient safety is much more important than Accreditation Myth Buster 12

13 Accreditation Represents a Risk Reduction Strategy (JCI) That an organization is doing the right things and doing them well; Thereby significantly reducing the risk of harm in the delivery of care; and Optimizing the likelihood of good outcomes. 13

14 Accreditation - Does it make a difference? 14

15 Does it make a difference? Accredited hospitals report significant improvements in: Leadership Medical records management Infection control Reduction in medication errors Staff training and professional credentialing Clinical outcomes 15

16 16 Certain adverse events, such as infections and decubiti, may be reduced by preventive protocols that are reflected in accreditation standards, whereas other events, such as failure to rescue and postoperative respiratory failure, may require multifaceted strategies that are less easily translated into protocols. Health Care Manage Rev, 2009, 34(3),

17 17 We only identified two studies for inclusion in this review, which highlights the paucity of high-quality controlled evaluations of the effectiveness of external inspection systems. No firm conclusions could therefore be drawn about the effectiveness of external inspection on compliance with standards. The Cochrane Library 2011, Issue 11

18 Accreditation to a hospital stimulates continuous improvement. It enables hospital in demonstrating commitment to quality care. It raises community confidence in the services provided by the hospital. It also provides opportunity to healthcare unit to benchmark with the best. 18

19 Although accreditation benefits all stake holders, patients are the biggest beneficiary. Accreditation results in high quality of care and patient safety. The patients get services by credentialed medical staff. Rights of patients are respected and protected. Patient satisfaction is regularly evaluated. 19

20 20 Staff in an accredited hospital are satisfied lot as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes. It improves overall professional development of Clinicians and Paramedical staff and provides leadership for quality improvement within medicine and nursing.

21 Benefits of Accreditation Shows commitment to quality Improves communication and collaboration within the organisation Promotes team building Increases credibility Demonstrates accountability Improves productivity Obtaining advice from surveyors (mentoring) 21

22 Auditing Standards 22 Quality System

23 Certification of Specialty Services Important in the final choice Accreditation Licensure Certification 23

24 ACHS accreditation EQuIP 224

25 Australian Health Service Safety and Quality Accreditation Scheme Advice Centre Network Meeting Margaret Banks Senior Program Director February 2013

26 Accreditation Canada Accreditation Canada is a national, nonprofit, independent organization whose role is to help health services organizations, across Canada and internationally, examine and improve the quality of care and service they provide to their clients. 26

27 Joint Commission International The most well known JCI, based in the U.S., is a division of Joint Commission Resources (JCR) and a subsidiary of the Joint Commission designed to improve and regulate the quality and safety of healthcare services. About 600 and growing foreign hospitals now accredited 27 27

28 JCI Accreditation Programs International Accreditation Programs and Start Dates: Hospitals 1997 *5 th Edition effective April 2014 as a part of demand on Global Trends with change in Medical technology / informatics. Ambulatory Care Clinics 1998 Clinical Laboratories 1998 Medical Transport 2003 Primary Care Centers 2009 Home Care 2012 Long Term Care Academic Medical Centers

29 JCI Other Initiatives with Global Medical Tourism in Mind International Patient Safety Goals 2007 Tracer Methodology 2007 Clinical Care Program Certification (CCPC) for Disease & Condition Specific Care 2010 Academic Diploma in Quality Management 2012 Academic Diploma in Infection Control Management 2012 JCI Library of 36 Measures 2013 Academic Medical Center & Research

30 JCI Clinical Care Program Certification (CCPC) 15 areas of clinical care are eligible for CCPC: - Heart Failure -Chronic Obstructive Pulmonary - Acute Myocardial Infarction Disease - Primary Stroke - Diabetes Mellitus (Types 1 and 2) - Chronic Kidney Disease - End-stage Renal Disease - Palliative Care (all types) - Cancer (all types) - HIV/AIDS Management - Asthma - Pain Management - Transplantation (all types) - Joint Replacement (all types) -Traumatic Brain Injury 30

31 International Society for Quality in Health Care(ISQua) A non-profit, independent organization with members in over 70 countries. ISQua works to provide services to guide health professionals, providers, researchers, agencies, policy makers and consumers, to achieve excellence in healthcare delivery to all people, and to continuously improve the quality and safety of care. JCI is accredited by ISQua 31 31

32 ISQua Accreditation Programme 32

33 Overview of Taiwan Area: 36,188km 2 Population: 23 million Capital city: Taipei GDP per capita: US$ 20,423 (2012) Literacy: 97.9% 33 Source: National Statistics, R.O.C. (Taiwan)

34 Healthcare Profile of Taiwan National Health Insurance (NHI) Program established in 1995 NHI Funds: approx.us$16 billion >99% people covered by NHI >93.5% medical institutions are voluntary contracted with NHI Total expenditure on health as % of GDP Average annual HC expenditure / person Hospital beds / 10,000 Physicians density / 1,000 Life expectancy at birth Taiwan (2012) Australia (2012) New Zealand (2012) Jordan (2012) 6.6% 9.1% 10.3% 9.8% US$1,350 US$6140 US$3,292 US$ (2009) 1.7 (2010) 3.9 (2010) Male 76 Female 83 Male 81 Female (2011) 2.7 (2010) Male 80 Female (2010) 2.6 (2010) Male 72 Female Source : WHO Statistical Information System

35 Introduction of Taiwan Joint commission on Hospital Accreditation (TJCHA) 35

36 Overview of TJCHA Established in April 1999 A not-for-profit, non-governmental organization (NGO) Founding Organizations: Ministry of Health and Welfare (MOHW) Taiwan Medical Association Taiwan Hospital Association Taiwan Non-governmental Hospitals and Clinics Association Inauguration Ceremony, April 12,

37 A Professional Accreditation Organization International Recognition Awarded by International Society for Quality in Healthcare (ISQua) The first in Asia, the eighth in the world Accreditation Organization, since 2006, until 2014 Accreditation Standards, since 2007, until 2015 Surveyor Training Programme, since 2014, until 2017 Taiwan Train Quality System Certified by Bureau of Employment and Vocational Training, Council of 37 Labor Affairs, Executive Yuan.

38 38 Taiwan Hospital Accreditation

39 Healthcare Accreditation in the World Year Country 1951 USA 1958 Canada 1974 Australia 1978 Taiwan 1989 New Zealand, China 1990 UK 1994 South Africa 1995 Finland, Korea, Indonesia 1996 Argentina, Spain 1997 Czech Republic, Japan 1998 Brazil, Poland, Switzerland 1999 France, Malaysia, Netherlands, Thailand, Zambia 2000 Portugal, Philippines 2001 Germany, Italy, Ireland Not Yet Colombia, Slovak Republic, Mongolia, Bosnia

40 TJCHA Diverse Business Accreditation/ Certification / Inspection Type/The number of on-site visits/year Hospital/Teaching Hospital Accreditation Psychiatric Rehabilitation Institution Accreditation Psychiatric Nursing Home Infection Control Inspection IRB Inspection Baby friendly Hospitals Chinese Medicine Institution Accreditation Emergent Medical Care Ability Classification Disease-specific Care Certification Health Check-up Certification Aesthetic Medicine Quality Certification PGY Training Institution Inspection Dentist PGY Training Institution Inspection Teaching 40 Hospital Subsidy Program Inspection Total

41 History of Hospital Accreditation in Taiwan The First Stage ( ) The Second Stage ( ) Teaching hospitals accreditation by Ministry of Health and Welfare (MOHW) and Ministry of Education All hospitals accreditation by DOH (Medical Care Act #28, #94,#95) MOHW Accreditation Hospitals The Third Stage (1999-current) Accreditation assumed by TJCHA 41

42 Taiwan Hospital Accreditation Evolution- 1/3 The First Stage : Teaching Hospital Accreditation accredited by Ministry of Education (MOE) and Ministry of Health and Welfare (MOHW). Teaching Hospital Grade First Second Third Equivalent to Medical Center Regional Hospital District Hospital 42 Start in 1978, teaching hospital is accredited once every two years.

43 Taiwan Hospital Accreditation Evolution - 2/3 The Second Stage: MOE officially transferred its Teaching Hospital Accreditation to MOHW, which began to offer accreditation. Hospital Type: Medical Center, District Hospital, District Teaching Hospital, and Specialty Teaching Hospital Scope: (1) staff, facility, hospital management, and community service (2) surgery (3) internal medicine (4) clinical laboratory (transfusion) and pathology (5) radiation (6) nursing (7) pharmaceutical (8) emergency medicine (9) psychology (10) infection control (11) teaching and clinical training 43

44 Taiwan Hospital Accreditation Evolution- 3/3 The Third Stage:1999-current MOHW entrusts TJCHA to conduct hospital accreditation program accreditation contract / accreditation fee MOHW Entrust accreditation program TJCHA Accreditation services Healthcare Organizations 44 TJCHA program contractor and think tank Draft accreditation SOP and standards 草擬評鑑作業程序 基準 Consult, develop policy/ SOP/ accreditation instruction 研商及發展評鑑相關決策 作業程序 規範 Implement (executor) 執行評鑑作業 Assist surveyor hiring / training/ evaluating 評鑑委員推薦 訓練 評核作業 Prepare accreditation results report 彙整評鑑結果報告 ( 成績 意見表 ) DOH authority and organizer Announce accreditation SOP and accreditation standards 公告評鑑作業程序 基準 Organizer and funding agent 主辦及經費提供者 Appoint accreditation surveyors 聘任評鑑委員 Convene Decision Meetings with TJCHA, senior surveyors and health officials for review and confirmation of accreditation results 召開評定會議核定評鑑結果 Endorse accreditation results 公告評鑑結果

45 Hospital Accreditation Standards Part Chapter Item Part Chapter Item Hospital Management Hospital Operations Strategy Staff Management and Support Systems Human Resource Management 15 Medical Care Rights and Responsibilities of Patient and Family Medical Care Quality Improvement Care Implementation and Evaluation 1.4 Staff Education and Training Care of High Risk Patients Medical Record, Information and Communication Management Facility and Environment Safety Patient-focused Service and Management Risk Management and Emergency Response 2.5 Medication Safety Anesthesia and Surgical 2.6 Care Infection Prevention and Control Clinical Laboratory, Pathology and Radiology Discharge / Transfer Planning and Continuity of care Hospital Management Part 102 Medical Care Part

46 Characteristics of Taiwan Hospital Accreditation Medical care law Solid SOP Surveyors act in fairness Transparent accreditation results Tied to insurance reimbursement Characteristics of hospital accreditation 46 46

47 % Hospitals participated in accreditation program 衛生福利部辦理 醫策會辦理 約 95 % 醫院已接受評鑑 全民健保開辦 醫院總數 合格醫院數 4 47

48 Set Up the Follow-up On-site Survey The 1 st year The 2 nd or 3 rd year Unannounced follow-up surveys Hospital /Teaching hospital accreditation validity period of 4 years The 4 th year Unannounced follow-up surveys Next accreditation 448 Start in 2010, if the hospital happens the major medical event, an immediate follow-up survey will be conducted. 48

49 Continuous monitoring project 繁瑣龐雜的文書作業 回溯式審閱資料 4 年 評鑑年 耗時費力的書審 時間軸 ( 年 ) 按月 / 季持續提報作業評鑑年簡化評鑑資料準備作業 評鑑日常化 醫院內部改善參考 持續性監測系統 49 49

50 Accreditation and Performance Measurement reported every season using IT system 評鑑 (Snapshot 相片 ) 成效量測 / 指標 (Videotape 錄影帶 ) Snapshot of the year 第 1 年第 2 年第 3 年第 4 年 50 50

51 Information Transparency Contents are The name of hospital Location Accreditation results Year Accreditation validity period Hospital phone number Address Hospital basic info Business data available at 551

52 Features of TJCHA Accreditation Hospital Accreditation Taiwan Voluntary or mandatory? An element of contract or reimbursement for insurance? One standard or multiple standards? Conduct by government or non-government agency? One or more accreditation organization? Accreditation cycle? Document review or on-site survey? Provide consultation services or mock survey? Free or charge? Accreditation results announce to the public? Voluntary Yes One standard Government (consign to independent agency) Only one Every 4 years On-site survey(1-2.5days) Consultation services Charge Yes 52

53 National Health Insurance Reimbursement Contract Type The Number of hospital ( as of March, 2012) Medical Center 19 Regional Hospital 88 District Hospital Source: Ministry of Health and Welfare, March 2012

54 Certification Programs Differing from accreditation, TJCHA s certification programs encourage medical care institutes to pursue the excellence in care of a specific service. 54

55 Certification Programs Voluntary, specialty Services Patient-focused Methodology Disease Care Certification (AMI, ACS, CAD) Health Check-Up Program Certification Aesthetic Medicine Quality Certification 55

56 Patient Safety Programs 56

57 57 Patient Safety Campaign in Taiwan 復原力 (Resilience) 2014 手術安全把關運動 Surgery Safety Team STEEPS 病安文化調查 (Patient Safety Culture) 品質突破系列 BTS Activity 推展通報系統及根本原因分析 TPR System &RCA 籌備台灣並安通報系統 Pilot study of Taiwan Patient Safety Reporting system 病安目標 Highlights National Patient Safety Goals 衛生署病安委員會 Patient Safety Committee, DOH 人因概念 (HFE) 2012 全國醫療改革論壇 National Healthcare Policy Revolution Meeting

58 Taiwan Patient-safety Reporting System (TPR) Developed by TJCHA in 2004 with funding support from MOHW, dubbed TPR TPR also represents temperature, pulse and respiration, which serve as the most important vital signs of life. The name TPR indicates that reporting system is vital in the management of patient safety

59 Taiwan Clinical Performance Indicator (TCPI) Participation is voluntary, Collect hospital level data Indicators as a means for quality improvement rather than an end of themselves Require further investigation and other quality improvement tools Help hospitals in: collecting data on a regular basis assessing own performance knowing better by aggregated data comparison fostering inter-facility benchmarking 559

60 Full Range of services by TJCHA Hospital accreditation Continuous monitoring project Certification of specialty services Quality measures Patient safety initiatives CME of medical personnel, and certified by ISQua in all 3 programme 60

61 61 Summary The assurance of quality of international healthcare services could be provided by well recognized accreditation programs. Accreditation checked mainly the basic requirement of patient safety. ISQua accreditated the quality of international accreditation programs. Certification of specialty services could be considered in choosing high quality services. International accreditation programs are in the developing stage.

62 Accreditation is a Journey. Not a Destination 62