Standards for improvement in health care: supervision, certification and accreditation in Europe Dr Charles Shaw Sept 2012 Durham EAN meeting 1
Established standards assessments National Licensing, inspection Supervision - Service facilities - Teaching International WHO: HPH, BFH JCI, ACI, ACHSI accreditation DNV accreditation ISO certification eg - 9000 series: q systems - 15189: medical laboratories Sept 2012 Durham EAN meeting 2
The Production Model of Quality Structure - Process - Outcome Sept 2012 Durham EAN meeting 3
10 common QI terms on Medline 1998-2007 Walshe IJQHC 2009 Sept 2012 Durham EAN meeting 4
Regulation Unsafe Competent Excellent Number of institutions Sept 2012 Standards compliance Durham EAN meeting
Quality improvement cycle 6
Health service Certification
indicators audit survey peer review Inspection Certification Health service
indicators audit survey peer review Inspection Certification Health service QM training
indicators audit survey peer review Inspection Certification Health service QM training payment
indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME
indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME management
indicators audit survey peer review Inspection Certification Health service QM training payment Peer pressure UG/PG training, CME management
indicators audit survey peer review Inspection Certification Health service QM training payment planning Peer pressure UG/PG training, CME management
Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management
Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management HIF
Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management QM training academics HIF
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
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
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
Quality improvement cycle 27
Health service Certification
indicators audit survey peer review Inspection Certification Health service
indicators audit survey peer review Inspection Certification Health service QM training
indicators audit survey peer review Inspection Certification Health service QM training payment
indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME
indicators audit survey peer review Inspection Certification Health service QM training payment UG/PG training, CME management
indicators audit survey peer review Inspection Certification Health service QM training payment Peer pressure UG/PG training, CME management
indicators audit survey peer review Inspection Certification Health service QM training payment planning Peer pressure UG/PG training, CME management
Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management
Certification indicators audit survey peer review Inspection Agency Health service QM training payment planning Peer pressure UG/PG training, CME management HIF
Certification indicators audit survey peer review Inspection Agency Health service planning payment Peer pressure UG/PG training, CME management QM training academics HIF
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
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
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
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
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
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
organisations 1951-2009 Sept 2012 Durham EAN meeting 51
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
Saturation of eligible market Sept 2012 Durham EAN meeting 53
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
Critical success factors Policy environment Healthcare financing Stakeholder participation Public information Critical mass size does count Sept 2012 Durham EAN meeting 55
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