While we continue to manage through the COVID-19 pandemic, it is important to reflect on the lessons learned. The response to COVID-19 has shown us that organisations with a commitment to- and competence in- quality, patient safety and accreditation are better prepared to effectively manage through a crisis. Published reports from around the globe continue to demonstrate the value of quality, safety and accreditation, providing a framework to guide healthcare facilities as they recover and rebuild. This pandemic should be a catalyst for innovation, to move into the next generation of quality and safety.
Role of quality and accreditation during a pandemic
Emergency management frameworks are based on the cycle of PREPARE, RESPOND, RECOVER and MITIGATE. Health systems that applied quality improvement and patient safety principles managed successfully through each of these phases.
For example, during the prepare phase, the use of prioritisation matrices such as the hazard vulnerability analysis provides a systematic approach to plan for potential hazards. South Korea illustrated this by using the lessons learned from their experience with MERS in 2015, implementing updated emergency plans when COVID-19 arrived.
When responding to disasters, organisations need to prioritise safety, to address threatening conditions and reduce risks of harm. COVID-19 made very visible the risks to both patients and healthcare workers from communicable diseases. A September 2020 World Health Organization (WHO) report identified that 14 per cent of COVID-19 cases are amongst healthcare workers, as high as 35 per cent in some countries. Hospitals with effective infrastructures and procedures for infection prevention and control were able to pivot their attention toward managing this novel virus.
The purpose of the recover phase is to learn from the organisation’s initial response to the emergency, then strengthen their processes to enhance organisational performance during the next emergency. By applying quality tools such as listening to the voice of the customer (patients and staff), conducting root cause analyses, collecting data, implementing corrective actions, organisations can improve their processes to be more effective. Multiple examples of process improvement – for patients, staff and organisations – have been published, including cohorting COVID-19 patients, reuse of Personal Protective Equipment (PPE), and collaborative communication.
Mitigation activities reduce the likelihood of occurrence or reduce the damaging effects of unavoidable hazards. The use of telehealth services and plexiglass separations are mitigating actions that use human factors engineering to remove or reduce the risk of viral transmission.
How has accreditation supported organisations during this pandemic?
Joint Commission International (JCI) standards provide healthcare organisations with an evidence-based framework, a toolkit of best practices that support and guide organisations to provide high quality, safe care during crises as well as ‘normal’ times. For example, the JCI Accreditation Standards for Hospitals, 7th Edition, require hospitals to have an emergency management plan that is maintained and tested, including plans for communicable disease outbreaks. The Quality Improvement and Patient Safety chapter define the components of a quality management programme, including the use of a standardised approach to improvement and management of safety events. In the Governance, Leadership and Direction chapter, hospitals are required to monitor their supply chains, to assure available, effective equipment and products. The importance of supply chain management has been painfully obvious during the COVID-19 pandemic, as health systems struggled with unavailable (or counterfeit) PPE, medications and ventilators.
Data from a JCI ‘voice of the customer’ survey identified the top challenge for hospitals has been managing ‘Resources and Assets’, including PPE. The physical, psychological and emotional toll on healthcare workers during the pandemic has been overwhelming. JCI standards include requirements for healthcare facilities to support the physical and mental health of their staff. Through these and many other standards, accreditation supports organisational readiness to effectively manage the challenges of a disaster.
The future is now
COVID-19 has exposed strengths yet revealed weaknesses within our healthcare systems globally. Changes that have been in development for decades, such as telehealth, were accelerated in implementation. But failures in our system – such as racial inequities, healthcare insurance coverage gaps, lack of single-source data centres – have been accentuated. It is time to reframe quality, safety and accreditation.
With the digital transformation, we are all experiencing through the expansion of technology, the next generation of quality – Quality 4.0 – has arrived for healthcare, as it has for other industries. COVID-19 has reinforced the criticality of quality and the need to incorporate technology, including the use of available data sources and advanced analytics. The literature on Quality 4.0 focuses on understanding and managing context when approaching a problem: leadership, culture, diversity, adoption and implementation. The quality professional needs both technical skills as well as the ‘soft’ skills of change management, communication and teamwork.
Over the past decades, healthcare has made significant improvements in patient safety. But our progress has been limited; harm still occurs globally at a high rate. According to the WHO, one in 10 patients are harmed while admitted to hospitals. Now is the time for a cultural transformation across the globe, to move healthcare toward high reliability and zero patient harm. Joint Commission has studied high reliability in healthcare, and identified three necessary pillars:
- Leadership that is committed to safety, setting the strategy and providing resources;
- Organisational culture focused on safety – for patients AND healthcare workers – as the priority;
- Performance Improvement, a data-driven approach to problem-solving, with all staff trained in the science of improvement
Now is also the time to revaluate accreditation, to recognise its multifaceted roles. COVID-19 has demonstrated the value of accreditation – to our patients, our communities and our healthcare staff. The JCI standards provide healthcare organisations with evidence-based guidance for continuous improvement. The accreditation process itself provides an assessment of performance, identifies opportunities for improvement, offers best practice recommendations, and inspires change. In our current crisis, accreditation offers the support that healthcare organisations need.
The risk of a global pandemic such as COVID-19 has been anticipated for decades. Healthcare has more tools available now than ever including advancements in clinical medicine, public health, technology, quality- and accreditation. There is evidence that this pandemic can be successfully managed with the application of quality tools and principles. Navigating into our changed world will require a renewed commitment to accreditation. These are the safeguards for the future of our global health.
Dr Leonhardt will be speaking at the ‘Quality, safety and accreditation in our changed world’ session on Saturday, 7 November, at the virtual Patient Safety