Caroline Ratner from IMTJ asked Brian Johnson, Chief Executive of the Australian Council of Healthcare Standards (ACHSI) and ACHS International (ACHSI) about international hospital accreditation and the work of the ACHS. IMTJ then talked to some senior healthcare management personnel from India, Bahrain, Saudi Arabia and UAE about their views on hospital accreditation and its importance in medical tourism.
What is ACHS’s role in international accreditation?
Brian Johnson
At present, ACHS delivers accreditation programmes and education/consultancy services in Australia, New Zealand, The Kingdom of Saudi Arabia, the Middle East, India, Sri Lanka and Hong Kong/China; accrediting over 1200 individual healthcare organisations. Interest from other Asia-Pacific countries has compelled ACHSI to expand its area of operations. During the past year ACHSI also hosted numerous delegations to Australia, from countries including South Korea, Malaysia, Vietnam, China and the United Arab Emirates.
ACHS also trains surveyors who conduct peer reviews of healthcare organisations. Our surveyor workforce totals over 400 dedicated healthcare professionals and health consumers, all trained through a surveyor training program which has been recognised internationally and is accredited by the International Society for Quality in Health Care (ISQua).
What is the purpose of accreditation?
The purpose of our accreditation is not to review against a checklist but to provide a thorough and realistic roadmap for improvement and to help organisations establish and sustain a culture that strives for excellence.
External and independent peer review is considered international best-practice for many industries, including healthcare. ACHS Surveyors are health-industry professionals and consumers trained to conduct reviews of healthcare organisations against the standards of the ACHS Evaluation and Quality Improvement Program (EQuIP).
The current edition of this programmes’s standards, EQuIP 4, was introduced in January 2007 and has increased the focus on consumer participation in healthcare and the need to provide evidence of clinical and organisational outcomes.
How does ACHS develop its standards and criteria?
We develop our standards and criteria through a collaborative approach, consulting with all stakeholders, including healthcare organisations, consumers and industry and government representatives.
When updating accreditation standards, bodies may review existing sets of standards internationally to inform their view of current best practice, however, for ACHS the thorough consultation process and review of literature and evidence plays a much greater role in standards development.
Do all the accreditation organisations throughout the world have similar criteria when awarding accreditation? Do you work together on standardising criteria?
The standards and criteria applied by any accreditation programme must reflect the local environment, both in terms of the required level of performance and what is achievable. However, there is substantial interaction across the world between established and developing accreditation programme providers. The International Society for Quality in Health Care (ISQua) plays a significant and expanding role in promoting this exchange of ideas and information, particularly through its International Accreditation Programme that ‘accredits the accreditors’. Through its principles for standards development and the accreditation programmes for accrediting organisations and surveyor training and development programmes, it promotes a consistent and internationally respected approach. In this way there is a substantial opportunity for standardising or making more consistent the criteria that are used.
How often are facilities re-inspected?
This may vary depending where an organisation is at in terms of their quality activities. Some organisations seek Certification through ACHS prior to undergoing an accreditation survey. This is typically for organisations still establishing their quality improvement processes or those new to accreditation or newly formed organisations.
Once a healthcare organisation is accredited through the ACHS Evaluation and Quality Improvement Program (EQuIP) they generally participate in a 4 year cycle of accreditation activities with two self-assessments and two onsite surveys during that 4 year period. This cycle exists to support continuous quality improvement rather than simply preparing for a survey event.
The IMTJ also spoke to some healthcare professionals involved in medical tourism in India, Bahrain, UAE and Saudi Arabia about their view of the importance of accreditation.
What role does international accreditation play in medical tourism?
Bahaa Eldin Fateha, MD, DrPH
Director of the Military Hospital
Royal Medical Services, Kingdom of Bahrain
It is my personal view that hospitals should seek accreditation by an international body to measure their performance particularly with regard to quality of care and efficiency of the health systems. Accreditation should be an important first step of a continuous process of quality improvement using reference standards and collaboration with other hospitals that are under the umbrella of the accreditation body.
Accreditation by an international body will make it easier for the patient to consider if the facility is worth visiting. If a patient is a making a choice between two healthcare facilities that provide similar services, accreditation of one will most likely tip the balance towards being the one the patient chooses.
Dr M I Sahadulla
Chairman and Managing Director
Kerala Institute of Medical Sciences
Trivandrum, India
International Accreditation plays an important role for medical travelers as it acts as a credibility stamp for the medical traveler to ensure that the institution will provide safe and quality care. It also ensures that the hospital meets international standards of care and quality treatment.
Do you think international patients are educated enough to know that they should go to an accredited facility?
Mr Richard Turner
Senior Vice President – Clinic Operations
Emirates Group
I would suspect that the average, general public would not know or understand the significance of accreditation and what it means. The concept of benchmarking or working to agreed standards within an accreditation framework is relatively new within the health services, only becoming known outside of the US, Canada and Australia within the last 20 years. My discussions with patient groups suggest that the amount of information available for the general public to know and understand the concept has been limited. This is an area where there is a need for more widespread public education.
However, I would suggest that individuals who would be travelling to undergo medical procedures are slightly different to the general public and are more likely to have researched the quality of the product and services they will be using. My intuition would be that these people would probably have developed knowledge of accreditation and be using it as one means to gauge the likely safety and quality of both the practitioners and facilities they will accessing.
Dr M I Sahadulla
Medical tourism has played a catalytic role in making the Asian hospitals strive for world-class quality standards. However, because accreditation is a recent phenomenon in the health sector in India; the knowledge regarding accreditation is not satisfactory among the general public. But there has been a gradual increase in the awareness regarding the importance of quality, thanks mainly to the increasing role of private players in the sector, especially in countries like India and China, where private sector hospitals have aggressively pursued accreditation.
Bahaa Eldin Fateha, MD, DrPH
We should never underestimate the level of knowledge of patients! With the availability of internet, patients do understand the meaning of accreditation, and they value accredited facilities due to the expected healthcare quality and overall efficiency. If a medical tourist is given a choice of attending an accredited hospital versus a non-accredited hospital, the choice would be clear: to go to an accredited one where the hospital services have been surveyed and thus the patient is assured of hospital's compliance with the required international standards.
What does being an accredited hospital/clinic mean to the facility?
Richard Turner
Accreditation is very important as it allows the organisation to say to its customer groups that it has undergone some form of external assessment which has been benchmarked to similar organisations and best practice; and that it has met the required standard which ensures it has the systems and process in place to provide safe and effective care.
Mrs Shaini Philipose
TQM Clinical Review Analyst
Dr Soliman Fakeeh Hospital
I believe that if your accreditation creates a culture of safety and quality within an organisation that strives to continually improve patient care processes and results.
Through accreditation the organisation has,
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Improved the public trust that the organisation is concerned about patient safety and quality of care
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Improved the staff satisfaction through safe and efficient work environment
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Strengthened leadership assurance to providing excellent care, quality improvement and achieving excellence
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Improved patient and customer satisfaction
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Promoted continuous Quality improvement
Bahaa Eldin Fateha:
Accreditation of a facility gives a significant sense of pride that the hospital is being recognised as satisfying key international standards of quality and efficiency. Accreditation is different from self-assessment as accreditation measures the standing of a hospital using a scale that is applicable to all; On the other hand, self assessment may be tailored to specific hospital or setting and carries the risk of individual bias. Accreditation by an international body eliminates to a greater extent such individual bias, which adds to the credibility of the accreditation process.
What does accreditation mean to patients?
Richard Turner
Accreditation provides surety to patients that the organisation is committed to improving the systems which enable it to provide high quality care. The fact that the organisation is accredited illustrates this commitment in a concrete manner. In addition to stay accredited an organisation needs to demonstrate ongoing improvement and undergo repeated assessment, meaning that it cannot rest upon it laurels.
Dr M I Sahadulla
Patients are the biggest beneficiaries of accreditation among all the stakeholders. For a patient it means that the healthcare facility has been certified for safety and quality. It gives a sense of security and an assurance for the patients and their bystanders.
It increases patient involvement in management of care. Protocol based treatment and clinical management based on open disclosure and clinical pathways ensures better understanding in patients and relatives regarding the mode of care provided. In short the rights of patients are respected and protected.
Dr Bahaa Eldin Fateha
Accreditation means a lot to patients – as it signifies attending a hospital that is recognised internationally as one of higher standards. This leads to higher demand on the hospital services and greatly increases the hospital standing among its peers. Indeed hospital reputation increases sharply as a result of accreditation. However, there is an important side-effect: Patients attending accredited hospitals have much higher expectations, and accredited hospitals should be aware of this fact.
