The emergence of antibiotic-resistant super bugs and the increasing incidence of infections in healthcare facilities have thrown into sharp relief the often sub-standard and unhygienic practices prevalent in many hospitals, clinics and other institutions. Add to that the quadruple burden of disease across Africa and the well-known shortage of healthcare workers, and you have the perfect storm for compromised healthcare.
Although well established in Europe and the USA, the formal accreditation of healthcare facilities is, however, beginning to make a real difference in the quality of healthcare being practised in developing countries.
Accreditation is an internationally recognised evaluation process used to assess and improve the quality, efficiency, and effectiveness of healthcare organisations. Simply put, accreditation is based on the premise that adherence to evidence-based standards will produce higher quality healthcare services in an increasingly safe environment. It is also a way to publically recognise that a healthcare organisation has met national quality standards (Pomey, 2005)i.
It is only in the past decade or so that serious research on the value and benefits of accreditation has begun to systematically appear in peer review literature.
In a ground-breaking literature review conducted by A. Alkhenizan and C. Shaw in 2011, 26 studies evaluating the impact of accreditation were identified.ii
“The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspeciality accreditation programmes to significantly improve the process of care provided by healthcare services by improving the structure and organisation of healthcare facilities. Several studies showed that general accreditation programmes significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programmes in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management.
The authors concluded: “There is consistent evidence that shows that accreditation programmes improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programmes improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programmes should be supported as a tool to improve the quality of healthcare services.”
In the current era of heightened fiscal responsibility, transparency, accountability, and escalating healthcare complexity and risks from the impact of global warming and climate change, accreditation contributes to ensuring that care meets the highest standards of healthcare decision-making and provision. Accreditation can serve as a risk mitigation strategy, and it can also measure performance; it provides key stakeholders with an unbiased, objective, and third-party review. It can constitute a management tool for diagnosing strengths and areas for improvement (Pomey, 2010).
Organisations that participate in accreditation confirm their commitment to quality improvement, risk mitigation, patient safety, improved efficiency, and accountability; it sends a powerful message to key decision-makers and the public. This performance measure contributes to the sustainability of the healthcare system. (Nicol, 2015)iii
The gathering evidence
An increasing number of academic studies are showing clear benefits of accreditation and it is both a logical and safe assumption that when medical interventions are performed by competent individuals, using appropriate, regularly serviced equipment in standard procedures regulated by written policies, risks are reduced, and outcomes will be better.
Academic papers, particularly in the past decade, increasingly point to the indisputable benefits of accreditation.
Although couched in the language of continuous quality improvement, the accreditation process is, at its core, a risk reduction activity. It begins with the setting of contemporary standards that address important organisational functions – for example, patient assessment, and medication usage – and then encourages organisations, through the awarding of accreditation, to comply with these standards. The operating thesis is that if organisations are doing “right things right” as reflected in the standards, then errors and adverse outcomes are less likely to happen than if there were no such standards. Notwithstanding the continued high frequency of errors, this thesis is almost certainly correct.iv
The El-Jardali et al study on the impact of accreditation on primary healthcarev, concluded, “This study demonstrated the positive impact of accreditation on PHC centres in several areas of quality and performance. Accreditation was associated with improved delivery of healthcare and quality…. Improvements in quality were reflected by the increase in customer satisfaction and several patients visiting PHC centres from various regions and social strata.”
One of the constant narratives that accreditation organisations hear from their accredited clients is the following: the initial objection to quality improvement and accreditation interventions is the cost factor. However, the systems that are put in place ensure that wastage is reduced, stocks are accounted for, and duplication is minimised results in saving – not least from a reduced number of malpractice suits – that most definitely outweigh the initial investment.
Web-based information system
COHSASA uses a web-based information system – CoQIS (the COHSASA Quality Information System) to identify and keep track of improvements in all sections of a hospital or health facility. CoQIS can be used by hospital managers as a management tool to monitor the quality of their operations. It provides easy, user-friendly, continuous access to current hospital standards compliance, which enables management to make informed decisions as to when and where to introduce quality improvement programmes and prepare for accreditation.
Designated staff in facilities (and in corporate headquarters) access their own data via a secure password online and track improvements and obstacles to improvement in situ. They are able to examine all the areas of service provision and support in their hospitals or clinics and capture progress in compliance levels from the deepest level – criteria level – to the highest and broadest level – performance indicators in a single hospital, across several hospitals in a region, or in one country.
Senior management can use CoQIS to monitor each hospital performance routinely, while it prepares for accreditation, and monitor the quality of operations in all hospitals, singly or in groups, to ensure that the hospitals achieve and maintain quality standards in all services beyond accreditation. It is a tool for the ongoing monitoring of performance indicators.
CoQIS provides clear and unambiguous guidance to hospital managers and health policy strategists on what is wrong with hospitals, how deficiencies can be fixed and what is most important to fix first so that patients are safe and legal requirements are met. This means that endemic weaknesses in hospital service delivery can be picked up, monitored and improved.
For hospital insurance schemes, the knowledge that a facility has been accredited means that safer and better outcomes of patient care can be expected.
The value of entering a quality improvement programme – culminating in accreditation – is that information on deficiencies and common trends empower management to implement macro strategies to optimise the use of finance and resources.
Uniform performance evaluation
There is value in a uniform performance evaluation because it informs budgeting and planning and identifies appropriate and cost-effective interventions. The addition of the internet based CoQIS to the COHSASA portfolio means timesaving and reduced costs of transport and accommodation to gather information.
Healthcare facilities that carry a COHSASA Accreditation Certificate and have successfully completed the demanding requirements of the programme can offer patients peace of mind that they are receiving treatment in a facility that is safe, clean and meets definite safety and legal requirements. Patients can rely on the fact that there are clearly defined methods of interaction in the hospital that ensure their well-being, that there are systems to detect weaknesses and monitor improvements as well as sufficient, properly trained staff to look after them.
There are some values attached to accreditation that cannot be quantified but only guessed at. Medical error, as the South African public sector – particularly – has been finding of late, carry a high financial cost. The proper systems required for compliance with standards of safety in both administrative and clinical operations in a healthcare facility means that accreditation may indirectly contribute towards preventing error. On that basis, the value of accreditation is incalculable.
COHSASA offers an adverse event reporting and monitoring system – PatSIS – which, combined with quality improvement and accreditation may prove to be a powerful set of tools to ensure that safe and better care is provided to patients. The reduction in costs associated with malpractice suits is therefore a given.
Marilyn Keegan represents The Council for Health Service Accreditation of Southern Africa NPC.This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today. Back to Management