Learning From Asia

8/3/2019 Learning From Asia

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Accreditation as aAccreditation as a

Regulatory ToolRegulatory Tooland QA:and QA:Learning from theLearning from theAsia ExperienceAsia ExperienceAssAssococ. Prof. Jiruth Sriratanaban,. Prof. Jiruth Sriratanaban,

M.D., M.B.A., Ph.D.M.D., M.B.A., Ph.D.

Department of Preventive and Social MedicineDepartment of Preventive and Social Medicine

Faculty of Medicine, Chulalongkorn UniversityFaculty of Medicine, Chulalongkorn University


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OutlineOutline

Health system needsHealth system needsfor quality assurancefor quality assuranceand hospitaland hospitalaccreditationaccreditation

System options forSystem options formanaging qualitymanaging quality

Hospital accreditationHospital accreditation

(HA) as regulatory(HA) as regulatory


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Roles of the Health SystemRoles of the Health System

World HealthWorld Health

Respect for patient rightsand more client orientation

Healthoutcome

improvement


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challenges forchallenges for

Thailands healthThailands healthcare systemscare systems Inequity due to malInequity due to mal--distribution of health resourcesdistribution of health resources Increasing health care expenditureIncreasing health care expenditure

Introduction of closeIntroduction of close--ended payment mechanisms byended payment mechanisms bythe major health security schemesthe major health security schemes

Expansions of business health sectors and theExpansions of business health sectors and thegovernmental Medical hub policiesgovernmental Medical hub policies

Threats againstquality of health care


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Alarming information fromAlarming information fromAdverse events studiesAdverse events studies

studystudy datedate Rate (%)Rate (%) DeathDeath PreventablePreventable

HMPSHMPS 19841984 33..77 1313..66 %% --UTCOSUTCOS 19921992 55..44 55..66 %% 5454%%

QAHCSQAHCS 19921992 1616..66 44..99 %% 5151%%

UKUK 19991999--20002000 1111..77 88..00%%%% 4848%%DenmarkDenmark 19981998 99..00 -- --

ThailandThailand(1)(1) 20020033 99..11 -- 7171%%


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System options for assuring qualitySystem options for assuring quality

of hospital Careof hospital CareSystem resources management (e.g., financingSystem resources management (e.g., financingreform, autonomous hospitals)reform, autonomous hospitals)

Licensure (Legal requirement for operation)Licensure (Legal requirement for operation)QualityQualityaudit (e.g., standards and guidelines)audit (e.g., standards and guidelines)

Quality assurance and quality management systemsQuality assurance and quality management systems(e.g., ISO, MBNQA, etc.)(e.g., ISO, MBNQA, etc.)

QualityQuality improvement (e.g., TQM, CQI, Indicatorsimprovement (e.g., TQM, CQI, Indicatorscomparison, Benchmarking, etc.)comparison, Benchmarking, etc.)

Quality assessment and accreditationQuality assessment and accreditation

Public disclosure of information on provider qualityPublic disclosure of information on provider quality


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Proposed Conceptual framework for the Master planProposed Conceptual framework for the Master planfor managing quality under NHSSfor managing quality under NHSS

(Sriratanaban, et al.(Sriratanaban, et al. 20052005))

Promoting

quality

Correcting

quality

Determinationof Quality

requirement

Promotion ofstandards and

guidelines

Resource

s

Beneficiaries empowermentand participation

Regulations

Payment

System mgt.

Information

Qualitymonitoring

y Health

outcomes

y Practicesy Satisfaction

y Complaints

Policy andmanagement

decision making

Managementsystems for

quality

2

3

4

5

Healthservices

1

Hospital accreditation


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Hospital accreditationHospital accreditationas a regulatory incentiveas a regulatory incentive

Improve quality of health careImprove quality of health carePatient safety and risk managementEvidence-based practiceContinuous learning and improvement

Stimulate and improve integration andStimulate and improve integration andmanagement of health servicesmanagement of health services

Reduce variation in care and healthReduce variation in care and healthcare costscare costs

Strengthen the publics confidence inStrengthen the publics confidence in

the quality of health carethe quality of health care


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What isWhat is

HospitalAccreditation ?HospitalAccreditation ?

Mechanisms for recognition of institutionalMechanisms for recognition of institutional

competencecompetence

By an independent accrediting bodyBy an independent accrediting body (Usually)(Usually)

Participation by professional groups

Applying hospital standards for optimal andApplying hospital standards for optimal and

achievable performanceachievable performanceEmphasis on continuous quality improvementEmphasis on continuous quality improvement

Hospital survey by external peer reviewersHospital survey by external peer reviewers

Voluntary participationVoluntary participation (Usually)(Usually)


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Examples of HA programs in AsiaExamples of HA programs in Asia

Many countries in AsiaMany countries in Asiahave hospital accreditationhave hospital accreditation

programs, for example,programs, for example,TaiwanTaiwanKoreaKorea

IndonesiaIndonesiaJapanJapanThailandThailandMalaysiaMalaysiaIndia In certain statesIndia In certain states


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ThailandThailand

Began as a research and development projectBegan as a research and development projectinin 19971997 under the Health System Researchunder the Health System ResearchInstitute (HSRI) with financial support fromInstitute (HSRI) with financial support fromWHO, TRF and HSRI of ThailandWHO, TRF and HSRI of Thailand

Collaboration for Hospital QualityCollaboration for Hospital QualityImprovement and AccreditationImprovement and Accreditation Institute for Hospital Quality ImprovementInstitute for Hospital Quality Improvement

and Accreditation (HAand Accreditation (HA--Thailand)Thailand)

Technical support by external consultantsTechnical support by external consultantsfrom Canada (Adapted Canadian approach tofrom Canada (Adapted Canadian approach toHA)HA)

3535 pilot public and private hospitalspilot public and private hospitals


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improvementimprovement

cyclecyclePlanPlan DoDo

CheckCheckActAct

Qualityhospital

HospitalHospital

CQI

Accredit

Accredit

QA/Standard

RM


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HA standard frameworkHA standard framework

(Thailand(Thailand 19991999--20052005))

Governance and policy directions[1], [2]

Resource management[3], [4], [5], [6], [7]

Patient care process and services[10], [15], [16], [17], [18], [19], [20]

Analysis, measurement

and improvement[8], [9]

Patients and other customers

Professional systems,

patient rights and

organizational ethics[11], [12], [13], [14],

Input Output

Health needs and

customers expectations

Health outcomes,

Satisfaction


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Institute ofHospital Quality Improvement and Accreditation, THAILAND

Leadership

Strategic planning

Focus on patientsAnd Patient rights

Staff focus

Process

management

Results

Information and knowledge management

Key hospital systems

Risk, Safety and QualityProfessional managementEnvironmental managementInfection prevention and control

Medical record systemMedication systemMedical laboratory systemRadiological systemWork with communitiesPatient care processes

EntryPatient AssessmentPlanning (Care & Discharge)Care DeliveryPatient & Family EmpowermentContinuity of Care

Health carePatient and customerFinancialHuman resourcesOrganization effectivenessLeadership and SocialHealth Promotion

Hospital andHealth care

servicesStandards

2006

PartIV

PartIIIPartII

PartI

Patient care processes

MBNQA/TQA Model


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Accreditation SurveyAccreditation Survey

Leadership interviewLeadership interview Clinical and support staff and teamClinical and support staff and team

interviewsinterviews Patient and family interviewsPatient and family interviews Observation of patient care and servicesObservation of patient care and services

providedprovided Building tour and observation of patientBuilding tour and observation of patient

care areascare areas Review of written documentsReview of written documents Review of patients medical recordsReview of patients medical records Evaluation of the organizationsEvaluation of the organizations

achievement of outcome measuresachievement of outcome measures


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Accredited hospital means Accredited hospital means

Organization commitment on qualityimprovement

Adequacy of health care resources with efficientmanagement

Existence of quality assurance and continuousquality improvement

Existence of mechanisms to promoteprofessional standards and ethics Service provision that protects patient rights

and promotes organization ethical practices

Quality patient care processes


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Potential impactsPotential impacts

Health systemHealth systemgovernancegovernance

System design andSystem design and

developmentdevelopment System financingSystem financing

Population healthPopulation health

KnowledgeKnowledgemanagement andmanagement andtransfertransfer

Clinical effectivenessClinical effectiveness

Patient empowermentPatient empowermentand decisionand decision--makingmaking

Professional andProfessional andpersonal developmentpersonal development

ManagementManagement

developmentdevelopment Quality systemQuality system

developmentdevelopment


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um er oum er o --accre eaccre e

andand

HPHHPH--certified hospitalscertified hospitals

0

10

20

30

40

50

60

Apr-

04

Jul-

04

Oct-

04

Jan-

05

Apr-

05

Jul-

05

Oct-

05

Jan-

06

Apr-

06

Jul-

06

Oct-

06

Jan-

07

Time (Month / Year)

N

umberofnew

accre

ditedor

certifiedhospitals

0

50

100

150

200

250

Accumulatednumber

HA HPH HPHA Acc.HA Acc.HPH Acc.HPHA


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Purchasing quality health carePurchasing quality health care

Social Security Scheme endorsement of HASocial Security Scheme endorsement of HA Special quota of registered beneficiaries for

accredited providers

National Health Insurance Scheme movementNational Health Insurance Scheme movement

Financial support for HA consultation programs

Financial bonus for accredited providers

Impacts for national health service systemsImpacts for national health service systems

Health promoting hospital Use of evidence-based practice

Disease management programs by NHSO

Humanized health care initiatives


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Lessons learned: Government rolesLessons learned: Government rolesin supporting accreditationin supporting accreditation

Policy endorsementPolicy endorsement Leverage for accreditedLeverage for accredited

hospitals and other financialhospitals and other financialincentivesincentivesConsideration in purchasingConsideration in purchasing

decisionsdecisionsAlignment ofHA with otherAlignment ofHA with otherregulating mechanismsregulating mechanisms Program acknowledgementProgram acknowledgement


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Lessons learned: Major barriersLessons learned: Major barriersto successful implementationto successful implementation

Unclear purpose andUnclear purpose andunrealistic expectationsunrealistic expectations

Inappropriate technicalInappropriate technicalapproachapproachFailure to involveFailure to involve

stakeholdersstakeholdersLack of motivation (Provider)Lack of motivation (Provider)Poor cooperation amongPoor cooperation amongprofessional andprofessional and

overnmental bodiesovernmental bodies

Learning From Asia

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