Accreditation as a Regulatory Tool and QA: Learning from the Asia Experience

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Accreditation as a Regulatory Tool and QA
Learning from the Asia Experience

• Assoc. Prof. Jiruth Sriratanaban,
• M.D., M.B.A., Ph.D.
• Department of Preventive and Social Medicine
• Faculty of Medicine, Chulalongkorn University

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Outline

• Health system needs for quality assurance and
  hospital accreditation
• System options for managing quality
• Hospital accreditation (HA) as regulatory
  incentive in Thailand
• Lessons learned from Thailand HA

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Roles of the Health System
Respect for patient rights and more client
orientation
Health outcome improvement

• World Health Report (2000)

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Some of major challenges for Thailands health
care systems

• Inequity due to mal-distribution of health
  resources
• Increasing health care expenditure
• Introduction of close-ended payment mechanisms by
  the major health security schemes
• Expansions of business health sectors and the
  governmental Medical hub policies

Threats against quality of health care
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Alarming information from Adverse events studies
study date Rate () Death Preventable
HMPS 1984 3.7 13.6 -
UTCOS 1992 5.4 5.6 54
QAHCS 1992 16.6 4.9 51
UK 1999-2000 11.7 8.0 48
Denmark 1998 9.0 - -
Thailand(1) 2003 9.1 - 71
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System options for assuring quality of hospital
Care

• System resources management (e.g., financing
  reform, autonomous hospitals)
• Licensure (Legal requirement for operation)
• Quality audit (e.g., standards and guidelines)
• Quality assurance and quality management systems
  (e.g., ISO, MBNQA, etc.)
• Quality improvement (e.g., TQM, CQI, Indicators
  comparison, Benchmarking, etc.)
• Quality assessment and accreditation
• Public disclosure of information on provider
  quality

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Proposed Conceptual framework for the Master plan
for managing quality under NHSS(Sriratanaban, et
al. 2005)
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Hospital accreditationas 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 publics confidence in the quality
  of health care

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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)

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Examples of HA programs in Asia

• Many countries in Asia have hospital
  accreditation programs, for example,
• Taiwan
• Korea
• Indonesia
• Japan
• Thailand
• Malaysia
• India (In certain states), etc.

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Thailand

• Began as a research and development project in
  1997 under the Health System Research Institute
  (HSRI) with financial support from WHO, TRF and
  HSRI of Thailand
• Collaboration for Hospital Quality Improvement
  and Accreditation
• Institute for Hospital Quality Improvement and
  Accreditation (HA-Thailand)
• Technical support by external consultants from
  Canada (Adapted Canadian approach to HA)
• 35 pilot public and private hospitals

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Quality improvement cycle
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HA standard framework(Thailand 1999-2005)
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Institute of Hospital Quality Improvement and
Accreditation, THAILAND
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Accreditation Survey

• Leadership interview
• Clinical and support staff and team interviews
• Patient and family interviews
• Observation of patient care and services provided
• Building tour and observation of patient care
  areas
• Review of written documents
• Review of patients medical records
• Evaluation of the organizations achievement of
  outcome measures

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Accredited hospital means

• Organization commitment on quality improvement
• Adequacy of health care resources with efficient
  management
• Existence of quality assurance and continuous
  quality improvement
• Existence of mechanisms to promote professional
  standards and ethics
• Service provision that protects patient rights
  and promotes organization ethical practices
• Quality patient care processes

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Potential impacts

• Health system governance
• System design and development
• System financing
• Population health
• Knowledge management and transfer

• Clinical effectiveness
• Patient empowerment and decision-making
• Professional and personal development
• Management development
• Quality system development

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Number of HA-accredited andHPH-certified
hospitals
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Purchasing quality health care

• Social Security Scheme endorsement of HA
• Special quota of registered beneficiaries for
  accredited providers
• National Health Insurance Scheme movement
• Financial support for HA consultation programs
• Financial bonus for accredited providers
• Impacts 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 roles in supporting
accreditation

• Policy endorsement
• Leverage for accredited hospitals and other
  financial incentives
• Consideration in purchasing decisions
• Alignment of HA with other regulating mechanisms
• Program acknowledgement
• Program financing
• Technical support networks
• Public relations and reward systems

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Lessons learned Major barriers to successful
implementation

• Unclear purpose and unrealistic expectations
• Inappropriate technical approach
• Failure to involve stakeholders
• Lack of motivation (Provider)
• Poor cooperation among professional and
  governmental bodies
• Under-funding and lack of governmental commitment
• Failure to learn