Standards for improvement in health care: supervision, certification and accreditation in Europe

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1 Standards for improvement in health care: supervision, certification and accreditation in Europe Dr Charles Shaw Sept 2012 Durham EAN meeting 1

2 Established standards assessments National Licensing, inspection Supervision - Service facilities - Teaching International WHO: HPH, BFH JCI, ACI, ACHSI accreditation DNV accreditation ISO certification eg series: q systems : medical laboratories Sept 2012 Durham EAN meeting 2

3 The Production Model of Quality Structure - Process - Outcome Sept 2012 Durham EAN meeting 3

4 10 common QI terms on Medline Walshe IJQHC 2009 Sept 2012 Durham EAN meeting 4

5 Regulation Unsafe Competent Excellent Number of institutions Sept 2012 Standards compliance Durham EAN meeting

6 Quality improvement cycle 6

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13 Health service Certification

14 indicators audit survey peer review Inspection Certification Health service

15 indicators audit survey peer review Inspection Certification Health service QM training

16 indicators audit survey peer review Inspection Certification Health service QM training payment

17 indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME

18 indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME management

19 indicators audit survey peer review Inspection Certification Health service QM training payment Peer pressure UG/PG training, CME management

20 indicators audit survey peer review Inspection Certification Health service QM training payment planning Peer pressure UG/PG training, CME management

21 Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management

22 Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management HIF

23 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management QM training academics HIF

24 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management Leadershi p QM training academics HIF

25 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management Professions Leadershi p QM training academics HIF

26 Certification indicators audit survey peer review Inspection Agency Health service MoH planning payment Peer pressure UG/PG training, CME management Professions Leadershi p QM training academics HIF

27 Quality improvement cycle 27

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34 Health service Certification

35 indicators audit survey peer review Inspection Certification Health service

36 indicators audit survey peer review Inspection Certification Health service QM training

37 indicators audit survey peer review Inspection Certification Health service QM training payment

38 indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME

39 indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME management

40 indicators audit survey peer review Inspection Certification Health service QM training payment Peer pressure UG/PG training, CME management

41 indicators audit survey peer review Inspection Certification Health service QM training payment planning Peer pressure UG/PG training, CME management

42 Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management

43 Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management HIF

44 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management QM training academics HIF

45 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management Leadershi p QM training academics HIF

46 Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management Professions Leadershi p QM training academics HIF

47 Certification indicators audit survey peer review Inspection Agency Health service MoH planning payment Peer pressure UG/PG training, CME management Professions Leadershi p QM training academics HIF

48 Terminology accreditation Applied originally to the recognition of teaching trainers, trainees, or training environments Applied to healthcare provider institutions from 1917 (American College of Surgeons) Currently used thus by World Bank, EC, national governments and ISQua Applied to recognition of competent assessors from 1948 (ISO), 2008 (EU) auditors, laboratories etc In the vocabulary of ISO, healthcare accreditation would be equivalent to certification. Sept 2012 Durham EAN meeting 48

49 Differences between ISO and healthcare accreditation Use of term accreditation Legal regulatory framework Standards development process, evidence base Linkage to professional and educational ethic Adaptation to healthcare Separation of standards, facilitation, assessment, awards Public information, transparency Sept 2012 Durham EAN meeting 49

50 Classic model of accreditation Voluntary participation Explicit standards for service Self-assessment phase Emphasis on self-development Visiting peer group Analytical feed-back and grading Independent authoritative agency Sept 2012 Durham EAN meeting 50

51 organisations Sept 2012 Durham EAN meeting 51

52 Responding accreditation organisations Albania Croatia Lebanon Saudi Arabia Argentina Czech Republic Lithuania Serbia Australia Denmark Malaysia South Africa (ACHS) Australia (AGPAL) England Mongolia South Korea Australia (QIC) France Netherlands Spain Bosnia (AAQI) Germany NZ (HDANZ) Switzerland Bosnia (AKAZ) India NZ (Telarc) Taiwan Brazil Japan Philippines Thailand Bulgaria Jordan Poland USA (DNVHC) Canada Kazakhstan Portugal USA (JCI) Colombia Sept 2012 KyrgyzstanDurham EAN Romania meeting USA (TJC) 52

53 Saturation of eligible market Sept 2012 Durham EAN meeting 53

54 DEV9 International hospital accreditation Organisation Hospitals accredited Aust ACHS 25 - India, Dubai, Bahrain and Hong Kong Canada Anguilla 1, Bermuda 2, Brazil 6, Italy 5, Kuwait 2, Saudi Arabia 3 Germany 7 - Austria JCI USA DNV TJC 253 hospitals in 36 countries 3 in Brazil, 1 in India US Military Hospitals in Germany, South Korea, Japan, Italy, Spain, England, Iceland South Africa 1 - Botswana Sept 2012 Durham EAN meeting 54

55 Critical success factors Policy environment Healthcare financing Stakeholder participation Public information Critical mass size does count Sept 2012 Durham EAN meeting 55

56 Climate change - external assessment Convergence: voluntary accreditation with regulatory supervision eg Australia, Canada Collaboration or competition: accreditation and ISO certification eg interpretations of ISO 9000 for healthcare; EC Reg 765/2008 Demand for external assessment of healthcare providers across borders eg Medical tourism, health insurance, flow of goods, skills, services Lack of recognised cross-border standards Sept 2012 Durham EAN meeting

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