Improving the Quality of Healthcare through Accreditation: A Patient Perspective
Medical tourism offers diverse opportunities for patients. It increases choice and affordability of treatments. However, an increasing range of options can be bewildering. Impressive hospital websites offer a vast range of services, in 5 star settings. The patient’s challenge is to find the hospital or clinic offering high quality care in a low risk setting amongst these well-marketed glossy websites.
Patients need unbiased information to make choices. Most will access this information via the Internet. They will be looking for a safe provider in a convenient destination, at an affordable price. Some will be at a vulnerable stage in their lives, making decisions about complex surgery or treatments, possibly planning to travel far from home.
The greatest concern of the majority of patients will be how to choose the hospital where they are least likely to suffer an adverse outcome. They will require reassurance that the standard of clinical care, including management of postoperative complications, is of the highest quality.
There are several key factors, which determine the level of safety in the healthcare setting. First, a hospital or clinic providing good clinical care depends upon its entire staff embracing a culture of delivering high quality healthcare and continual improvement in the standard of care offered. It will also ensure that care is provided by appropriately qualified staff that have regular training to ensure they have the required skills to perform procedures, in an environment where risk is minimized.
Importantly, staff will be made aware of the safest ways to practice. There will be policies available to staff with regular training to ensure staff have awareness of and understand these policies. A system will be in place to know exactly how good the care provided is. By performing regular audits to measure current performance against best practice, a cycle of continual improvement can be established.
In any healthcare setting some risk will always exist. Human error can never be entirely eradicated. The wise organization will take the opportunity to learn from mistakes or near misses. An adverse incident provides a way to offer learning to others, only if a mechanism exists to share knowledge rather than blame individuals.
The Significant Event Analysis of incidents, or near misses, facilitates team learning by involving all relevant staff in a discussion of the causes of the event, and identifying ways to avoid a repetition. This learning can be passed on to the whole organization resulting in risk reduction for all patients. In a similar way, good practice can be identified and shared.
The setting of the care will be compliant with health and safety regulations, with a method of ensuring that regular checks take place. Designated members of staff will be responsible for key areas, such as infection control.
So how does a patient begin to assess whether the hospital takes these factors seriously from the information available on the website?
One way is to look for hospitals that have undergone an external review of quality standards, by a credible body, which has taken all of these factors into account. Healthcare providers are increasingly looking towards International Accreditation to reassure patients about the care they can expect.
A hospital that has been successful in achieving accreditation has been inspected by an independent accreditation body. The quality of care and the setting of that care have been carefully assessed to ensure that risk has been minimized.
Accreditation looks at the whole organization, from management to clinical care. The aim of accreditation in healthcare is to improve patient services. The standards that the facility is assessed against should be patient centred, and the survey should test thoroughly how well the standards are adhered to in practice.
Schemes such as Trent use a survey team of active NHS Professionals, all of whom have current knowledge of healthcare provision, to assess the application of standards and procedures in practice. Surveyors spend most of their time on the wards, talking to staff and patients and observing processes in action.
Developmental accreditation programs support the organization in achieving improvements by sharing best practice and offering ongoing mentoring support during the preparatory phase.
For the organization, accreditation provides much more than a marketing tool. The preparation for an accreditation survey involves all staff, clinical and non clinical, in a process of understanding how the organization works and how, by working as a team, patient and staff risk can be minimized.
This common goal improves communication, with cross-departmental work being necessary to achieve the required standards. A successful survey results in improved staff morale, and pride in the standard of care offered. Insurers can be assured of the risk minimization processes in place.
There are several International Accreditation schemes available and hospitals should take time to assess fully the benefits and costs of the various schemes. Factors to be taken into account include the target client group, preparatory work required by the scheme and full costs of the accreditation process.
The Accreditation Body itself should be subject to regulation. Commercial schemes should be accredited by bodies such as ISQUA in order to ensure the quality of their processes. Non commercial schemes such as Trent Accreditation Scheme, which is part of the UK NHS, are subject to rigorous NHS governance systems.
Costs vary widely, even in the not for profit sector, both for the cost for the accreditation survey and the preparatory training required. It is essential to be clear about the total costs to be expected at the beginning of the process.
Ultimately, accreditation should improve patient experience and result in fewer adverse patient outcomes. Affordability of accreditation has deterred many good hospitals and clinics from engaging in the process. Different healthcare settings have different needs and will benefit from different schemes.
An analysis of the hospital or clinic’s requirements from accreditation, their target patient group and budget followed by a detailed discussion with accreditation bodies should result in finding the right Accreditation Body to meet those needs.
The importance of accreditation is in the ability of the process to alter the culture of a healthcare setting into one of continual improvement in quality. A successful accreditation survey represents a commitment to quality, which is recognized externally. Of equal importance is the continued focus on the maintenance and improvement of patient care between surveys and the engagement of staff in the process.
Accreditation at its best should make patients safer, and develop healthcare settings where staff can develop and thrive.
Dr. June Smailes is a Board Member and Lead Surveyor, Trent Accreditation Scheme.Trent Accreditation Scheme is a not-for-profit Accreditation Scheme based within the UK National Health System, which has operated internationally since 1999. As a developmental Scheme, it offers affordable accreditation to any size of healthcare facility. The Trent survey process is paper- light with an emphasis on the practical application of policies. For further information email June.Smailes@trentaccreditationscheme.org