Building Public-Private Partnership for Health System Strengthening An Overview of Accreditation Dominic Montagu Bali H

1. Building Public-Private Partnership for Health System Strengthening An Overview of Accreditation Dominic Montagu Bali Hyatt Hotel, Sanur, Bali 21-25 June 2010

2. Terminology: Accreditation & External Quality Assessment • Accreditation: • A voluntary and regular evaluation by non-partisan external professionals, to determine compliance with a set of agreed upon standards- adapted from E. Scrivens 1995 • External Quality Assessment: • An independent assessment against explicit published standards by an independent function within the organization (2nd party assessment) or an external assessment (3rd party assessment) • As opposed to: • Certification: written testament of ability • Licensure: authorized by legal grant or permission • Authorization: made legitimate by authority • Inspection: viewed and examined officially • Regulation: controlled by restriction- E. Scrivens 1995 • Examples: • National Assoc. of Medical Aid Societies in Zimbabwe • LSHTM Phnom Penh accreditation pilot • UNICEF Baby Friendly Hospital Initiative • PROQUAL, Brazil (JHCCP, MSH) • Marie Stopes International, Pakistan

3. Accreditation of… • Hospitals common • Clinics occasionally • Blood Banks relatively common • Laboratories somewhat common • Physicians unsuccessfully

4. Accreditation • Usually a voluntary process by which a government or non-government agency grants recognition to health care institutions which meet certain standards that require continuous improvement in structures, processes, and outcomes

5. Differences • National Accreditation Associations • HQIA, MSQH, etc • International Organization for Standardization (ISO) • e.g.: ISO 9002 • Joint Commission International (JCI) • International Society for Quality in Health Care (ISQua)

6. Why accreditation? Accreditation represents a risk-reductionstrategy which means that the organization: • is doing the right things and doing them well; • Is significantly reducing the risk of harm in the delivery of care; and • is optimizing the likelihood of good outcomes

7. Major components of the quality assurance process Standards Assessment Response

8. What drives hospitals’ patient safety efforts in the USA? • Health Affairs Volume 23, Number 2, 2004 • The most frequently mentioned initiatives either explicitly noted they were designed to meet JCAHO initiatives, or mapped back to JCAHO policies and requirements. • The only frequently mentioned activity not directly linked to JCAHO was IT

9. A typical public hospital’s progress through the Graded Recognition Program

10. Cost to a Hospital • US: The least expensive hospital survey was 2 surveyors for 2 days and $7,800 • S.Africa: average $15,000/hospital

11. How Does Accreditation Work? • Creating a Culture of Safety • How is care provided? • How are errors perceived? • How are the reporters of errors perceived? • Are they rewarded or punished? • What are the barriers to reporting? • How does the environment allow errors to occur? • Changing Culture • Make the safest thing to do, the easiest thing to do • Lessons from aviation • Dishonorable not to report • Neutral party reporting • Separate from performance review • Leadership involvement and commitment

12. Thailand: Hospital Quality Improvement and Accreditation (HQIA) Total ISO ~16 Total JCI ~9

13. Malaysia: Malaysian Society for Quality in Health • 83 Government and 21 Private hospitals participating • 66 Hospitals accredited as of 2007 • Aligned with International Standards

14. Readings • Shaw 2005 – WHO Accreditation Toolkit • Shaw 2004 – Quality and accreditation in health care services, a global review • Montagu 2002 – Accreditation and other External Quality Assessment Systems for Healthcare All available at www.ps4h.org/resources