Hospital accreditation
Encyclopedia
Hospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”. Critically, accreditation is not just about standard-setting: there are analytical, counseling and self-improvement dimensions to the process. There are parallel issues around evidence-based medicine
, quality assurance
and medical ethics
(see below), and the reduction of medical error
is a key role of the accreditation process. Hospital accreditation is therefore one component in the maintenance of patient safety
.
Broadly speaking, there exist two types of hospital accreditation:
s and healthcare services are vital components of any well-ordered and humane society, and will indisputably be the recipients of societal resources. That hospitals should be places of safety, not only for patients but also for the staff and for the general public, is of the greatest importance. Quality of hospitals and healthcare services is also of great interest to many other bodies, including governments, NGOs targeting healthcare and social welfare, professional organisations representing doctors, patient organisations, shareholders of companies providing healthcare services, etc. However, accreditation schemes are not the same thing as government-controlled initiatives set up to assess healthcare providers with only governmental objectives in mind - ideally, the functioning and finance of hospital accreditation schemes should be independent of governmental control.
How quality is maintained and improved in hospitals and healthcare services is the subject of much debate. Hospital surveying and accreditation is one recognised means by which this can be achieved.
It is not just an issue of hospital quality. There are financial factors as well. For example, in the USA, up until recently the Joint Commission exercised a de facto veto over whether or not US hospitals and other health providers were able to participate, and therefore earn from, the Medicare
and Medicaid
programs. This situation has changed in recent years.
The different accreditation schemes vary in quality, size, intent and the skill of their marketing. They also vary considerable in terms of the cost incurred by hospitals and healthcare institutions. They have varying degrees of commitment to assessing medical ethical
standards and clinical standards.
They all have web sites.
work outside of their base country. One of the large number of accreditation schemes in the USA, the Joint Commission currently being the best known, has created Joint Commission International, or JCI
.
The former Trent Accreditation Scheme (TAS) from the UK was the first to accredit a hospital in Asia, in Hong Kong in 2000 http://www.union.org/new/english/about_us/mission.htm, and QHA Trent Accreditation
continues this work. Since TAS started the process, others, such as JCI
, have entered the market.
DNV Healthcare is a Norwegian-US health care accrediting organisation providing a quality management system
constructed in accordance with ISO 9001 and approved by the U.S. Centers for Medicare and Medicaid Services
(CMS).
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, quality assurance
Quality Assurance
Quality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...
and medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
(see below), and the reduction of medical error
Medical error
A medical error may be defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.-Definitions:As a general...
is a key role of the accreditation process. Hospital accreditation is therefore one component in the maintenance of patient safety
Patient safety
Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
.
Broadly speaking, there exist two types of hospital accreditation:
- Hospital and healthcare accreditation which takes place within national borders
- International healthcare accreditationInternational healthcare accreditationDue to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
.
Background
HospitalHospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s and healthcare services are vital components of any well-ordered and humane society, and will indisputably be the recipients of societal resources. That hospitals should be places of safety, not only for patients but also for the staff and for the general public, is of the greatest importance. Quality of hospitals and healthcare services is also of great interest to many other bodies, including governments, NGOs targeting healthcare and social welfare, professional organisations representing doctors, patient organisations, shareholders of companies providing healthcare services, etc. However, accreditation schemes are not the same thing as government-controlled initiatives set up to assess healthcare providers with only governmental objectives in mind - ideally, the functioning and finance of hospital accreditation schemes should be independent of governmental control.
How quality is maintained and improved in hospitals and healthcare services is the subject of much debate. Hospital surveying and accreditation is one recognised means by which this can be achieved.
It is not just an issue of hospital quality. There are financial factors as well. For example, in the USA, up until recently the Joint Commission exercised a de facto veto over whether or not US hospitals and other health providers were able to participate, and therefore earn from, the Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs. This situation has changed in recent years.
National schemes
Accreditation schemes recognised as providers of national healthcare accreditation services include:- Malaysian Society for Quality in Health, or MSQH - based in Malaysiahttp://www.msqh.com.my/
- QHA Trent AccreditationQHA Trent AccreditationQHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...
- based in the UK-EuropeEuropeEurope is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
http://www.qha-international.co.uk/home - Australian Council for Healthcare Standards International, or ACHSI - based in AustraliaAustraliaAustralia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
http://www.achs.org.au/ACHSI/ - Accreditation Canada, formerly known as Canadian Council on Health Services Accreditation, or CCHSA - based in CanadaCanadaCanada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
http://www.accreditation.ca/ - Healthcare Facilities Accreditation ProgramHealthcare Facilities Accreditation ProgramThe Healthcare Facilities Accreditation Program , is a not-for-profit organization dedicated to helping healthcare organizations maintain the highest standards in patient care and comply with ever-changing government regulations and a constantly evolving healthcare environment.Headquartered in...
(HFAP) -based in the USA http://www.hfap.org/ - Joint Commission (JC) - based in the USA http://www.jointcommission.org/
- Community Health Accreditation ProgramCommunity Health Accreditation ProgramThe Community Health Accreditation Program is an independent, US not-for-profit accrediting body and is an alternative to the Joint Commission...
(CHAP) - based in the USA http://www.chapinc.org/ - Accreditation Commission for Health CareAccreditation Commission for Health CareThe Accreditation Commission for Health Care is a US non-profit health care accrediting organization. It represents an alternative to the Joint Commission....
Inc. (ACHC) - based in the USA http://www.achc.org/ - The Compliance TeamThe Compliance TeamThe Compliance Team Inc., is a US for-profit organization which runs the "Exemplary Provider" accreditation programs, a US-based alternative to the Joint Commission...
: "Exemplary Provider Programs" - based in the USA http://www.exemplaryprovider.com/ - Healthcare Quality Association on AccreditationHealthcare Quality Association on AccreditationThe Healthcare Quality Association on Accreditation is a US not-for-profit health care accrediting body and is an alternative to the Accreditation Commission for Health Care and Joint Commission...
(HQAA) - based in the USA http://www.hqaa.org/default.asp - DNV Healthcare Inc. DNVHC - based in NorwayNorwayNorway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
and the USA http://www.dnvaccreditation.com http://www.dnv.com/industry/healthcare/ - Thailand Hospital HA - based in Bangkok, Thailand http://www.ha.or.th/index2008.asp
- Taiwan Joint Commission on Hospital Accreditation (財團法人醫院評鑑暨醫療品質策進會) - based in TaipeiTaipeiTaipei City is the capital of the Republic of China and the central city of the largest metropolitan area of Taiwan. Situated at the northern tip of the island, Taipei is located on the Tamsui River, and is about 25 km southwest of Keelung, its port on the Pacific Ocean...
, TaiwanTaiwanTaiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
http://www.tjcha.org.tw - La Haute Autorité de Santé, French National Authority for Health, based in Paris, France http://www.has-sante.fr/portail/jcms/c_5443/english?cid=c_5443
The different accreditation schemes vary in quality, size, intent and the skill of their marketing. They also vary considerable in terms of the cost incurred by hospitals and healthcare institutions. They have varying degrees of commitment to assessing medical ethical
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
standards and clinical standards.
They all have web sites.
International schemes
Some accreditation schemes also undertake international healthcare accreditationInternational healthcare accreditation
Due to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
work outside of their base country. One of the large number of accreditation schemes in the USA, the Joint Commission currently being the best known, has created Joint Commission International, or JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
.
The former Trent Accreditation Scheme (TAS) from the UK was the first to accredit a hospital in Asia, in Hong Kong in 2000 http://www.union.org/new/english/about_us/mission.htm, and QHA Trent Accreditation
QHA Trent Accreditation
QHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...
continues this work. Since TAS started the process, others, such as JCI
JCI
JCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
, have entered the market.
DNV Healthcare is a Norwegian-US health care accrediting organisation providing a quality management system
Quality management system
A quality management system can be expressed as the organizational structure, procedures, processes and resources needed to implement quality management.-Elements of a Quality Management System:# Organizational structure# Responsibilities# Methods...
constructed in accordance with ISO 9001 and approved by the U.S. Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS).
See also
- AccreditationAccreditationAccreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
- International healthcare accreditationInternational healthcare accreditationDue to the near-universal desire for quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process...
- Health insuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
- Hospitals
- Evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
- List of healthcare accreditation organisations in the USA
- Patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
- Medical ethicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- United Kingdom Accreditation ForumUnited Kingdom Accreditation ForumFounded in June 1998 by a group of leading healthcare accreditation organisations, the United Kingdom Accreditation Forum is a London-based network of healthcare accreditation organisations formed with the intention of sharing experience regarding good practice in accreditation, as well as sharing...
External links
- Rawlins R. Hospital accreditation is important. BMJ 2001;322:674
- Role of WHO in hospital accreditation. © 2004 WHO Regional Office for the Eastern Mediterranean
- Partners Harvard Medical International: Making Quality the Competitive Edge.
- United Kingdom Accreditation Forum.
- Robinson R. Book Review - "Accreditation: Protecting the Professional or the Consumer?" BMJ 1995;311:818-819.
- Gupta J & Das B. Developing national accreditation systems: Needs, challenges & future directions. Express Healthcare Management, November 2005. © Indian Express Newspapers (Mumbai) Limited.