Transcript Presentacion Paul Va..

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Service Summit
10-12 September 2009
Guatemala
Paul vanOstenberg
Senior Executive Director
Accreditation and Standards
Joint Commission International
© Copyright, Joint Commission International
The Cost and Value of
Accreditation: the JCI Experience
– Some facts about Joint Commission
International (JCI)
– Accreditation and Licensure basics
– The JCI accreditation process
– The cost of accreditation
– The drivers for accreditation
– Potential return on the investment
– Medical travel and accreditation
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Presentation Topics
Organizational Base
– Joint Commission International (JCI) is the
international arm of The Joint Commission (TJC).
– Established 1997
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– TJC and JCI are independent, non-profit, nongovernmental agencies
Mission of
Joint Commission International
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– To improve the safety and quality of
care in the international community through
the provision of education, publications,
consultation, evaluation, and accreditation
services
–
–
–
–
–
–
–
Hospitals (1999) – 3rd Edition (2007)
Laboratories (2002) – 2nd Edition (2009)
Medical Transport (2002)
Care Continuum (2003)
Ambulatory Care (2005) – 2nd Edition (2009)
Disease-Condition-Service Certification (2005)
Primary Care (July 2008)
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International Accreditation and
Certification Programs
JCI Accredited Organizations
Demark
Ireland
JCI European Office
Cz. R.
Aus
Swz.
Ferney-Voltaire, France
JCI Headquarters
Germany
Italy
Spain
Chicago, USA
Turkey
S. Korea
China
Bermuda
Lebanon Jordan
Pakistan
Egypt
Mexico
Taiwan
Qatar
Saudi
Arabia
UAE
India
Bangladesh
Hong Kong
JCI Middle East Office
Dubai, UAE
Thailand
Philippines
Barbados
Costa Rica
Ethiopia
Malaysia
Singapore
JCI Asia-Pacific Office
Singapore
Chile
To date, more than 266 in 38 countries
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Indonesia
Brazil
Accreditation – A Definition
– Usually a voluntary process by which
a government or non-government
agency grants recognition to health
care institutions which meet certain
standards that require continuous
improvement in structures,
processes, and outcomes.
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Accreditation – A Definition
– Licensure-governmental activity that
sets minimum standards to protect the
public
– Certification- evaluates special
capability or unique skills/ability
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– Accreditation is often confused with:
– International Board of Directors (of JCR)
– International Accreditation Committee
– International Standards Committee
– Regional Advisory Councils
– Four International Offices
– International translations of many products
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International Structure
Hospital Standards
–
–
–
–
–
–
–
Access to Care and Continuity of Care
Patient and Family Rights
Assessment of Patients
Care of Patients
Anesthesia and Surgical Care
Medication Management and Use
Patient and Family Education
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– Patient-Centered Standards
Hospital Standards
–
–
–
–
–
–
Quality Improvement and Patient Safety
Prevention and Control of Infections
Governance, Leadership, and Direction
Facility Management and Safety
Staff Qualifications and Education
Management of Communication and Information
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– Health Care Organization and Management
Standards
– Over 300 standards
– Over 1000 criteria measured during the
survey/evaluation process
– Required compliance with the
International Patient Safety Goals
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Hospital Standards
– Teams of peers gather information on-site
– Teams trace patients through the
organizations to evaluate systems of care
– The compliance elements and scoring
method is transparent
– Decisions on accreditation are rule based
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Evaluation Methodology
Patient Tracer
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Follows the care and needs of the patient
Costs of JCI Accreditation for
Hospitals
– According to the JCI website, the average cost to a
hospital for an accreditation survey is
– Larger hospitals will be charged more (larger teams,
longer surveys)
– Smaller hospitals will pay less
– If a repeat visit is necessary, it will usually be by a single
surveyor; the hospital will be charged a fee
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– USD 42,000 professional fees
– Plus transportation and maintenance of surveyors
– This is an “average” and does not correspond to any particular
configuration of surveyors, but most teams consist of 3 surveyors
Costs of JCI Accreditation for
Other Organizations
– Other organizational surveys are priced
similar to that of hospitals
– Disease-Condition-Service Certification
can be usually accomplished by one
additional surveyor at the time of the
survey
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– But in most instances only one or two
surveyors are needed
– So the cost will be less
Costs of Preparation for
JCI Accreditation
– Precise prediction of these costs impossible
– If a good quality management program is already
in place, the hospital may not need outside
assistance in preparing for accreditation.
– Often there is a need to design new systems,
processes, procedures, forms, etc. even in well
managed institutions. For this situation, external
assistance can be very beneficial.
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– Variable size organizations
– Variable status of compliance with JCI standards
– Variable interest in getting it all done in house or seeking
outside assistance
– Addition of staff – e.g. a quality manager, infection control
coordinator, quality data analyst.
– Upgrade of IT – e.g. for patient record management, professional
communications, quality data collection and analysis.
– Upgrade of facility – e.g. fire safety related equipment, physical
hazard reduction, privacy partitions in patient rooms, larger
capacity back-up generator.
– Reassignment of staff – e.g. to provide staff training, develop
policies, support teams working on improvement efforts or time for
team meetings during working hours.
– Outside assistance - e.g. for education, base-line assessment,
mock survey to ensure readiness, support to strategic
improvement plan.
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Types of Preparation Related Costs
– Aging populations with multiple chronic
diseases have raised costs of care
– Emergence of new diseases and HAIs
– Movement of patients and health care
HA
practitioners across borders
– Globalization of service and
NA
manufacturing sectors
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Drivers for Accreditation
How safe is healthcare?
100,000
Safe
(<1/100K)
Risky
Healthcare
Regular air
transport
Driving
10,000
1000
100
10
Mountain
climbing
Bungee
jumping
Chemical
industry
European
railways
Charter
flights
Nuclear
power
1
Contacts / 1 death
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Deaths / year
Dangerous
(>1/1000)
Sir Cyril Chantler, former Dean
Guy’s, King and St. Thomas’s Medical
and Dental School, Lancet 1999
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“Medicine used to be simple, ineffective
and relatively safe. Now it is complex,
effective and potentially dangerous.”
– Improved care – fewer complications
– Better reputation -- increased number of
new patients
– More satisfied staff – better retention and
lower recruitment and training costs
– More efficient, cost effective work
processes
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Potential Returns on Accreditation
– Better preventive maintenance program –
longer life of biomedical equipment
– Special recognition from payment sources
and insurance companies
– Greater clarity to leadership structure and
quality oversight
– Better safety management, and risk
reduction – reduced liability
exposure
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Potential Returns on Accreditation
Questions to Ask
– How does accreditation lead to enhancement
of patient and staff safety?
– Is it a result of compliance of standards?
– Or is it a function of the survey methodology?
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– Do you have the data to prove what you are
telling us?
Decreases in Medication Errors
Medication error rate at Indraprasthra
Apollo Hospital, Delhi, India
50.00
45.00
40.00
35.00
30.00
25.00
15.00
10.00
5.00
0.00
Jan
Feb
Mar
Aprl
May
05
Jun
06
July
Aug
UCL
Sep
Oct
Nov
Dec
CR
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20.00
Improvement in Documentation
Trend on Non Compliance of Allergy Documentation at
11.07
10
8
6.40
6
4.74
4
2
1.90
0.93
0
0.3
0
0
Jul-07
Jun-07
May-07
Apr-07
Mar-07
Feb-07
Jan-07
Dec-06
Nov-06
Desired
Outcome
0.5
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% Noncompliance
12
Reduction of Complications at
American Hospital, Dubai, UAE
–During preparation for re-accreditation:
12
10
8
6
2005
2006
4
2
0
VAP
UTI
BSI
Post-C/S
Infx (%)
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N/100 device days
– Emphasis on prevention of hospital associated
infections
– New Clinical guidelines introduced
Reduction of Ventilator-Associated
Pneumonia at
30.00
25.00
20.00
15 . 0 0
10 . 0 0
5.00
0.00
J a n- 0 5
Fe b- 0 5
Mar- 05
A pr - 0 5
May- 05
J un- 0 5
J ul - 0 5
A ug- 0 5
S e p- 0 5
Oc t - 0 5
N ov - 0 5
Dec- 05
Month
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Rate/1000 ventilator days
35.00
QIP ON VAP REDUCTION
COMPLETED
Moving Average - VAP - Year 2005
Reduction of Ventilator-Associated
Pneumonia
Month wise Hospital Acquired Infection Survelliance Data (VAP)
60
50
49.2
47.2
43.4
44.12
40
33.71
30
10.75
9.43
11.7
10
NNIS
5.61
7.09
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
0
0
0
0
Oct-06
Nov-06
Dec-06
VAP (No./1000 days)
43.4
11.7
49.2
47.2
9.43
33.71
44.12
10.75
7.09
0
0
0
5.61
Average
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
20.17
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
8.9
NNIS 90 percentile
Month
*(Number of ventilator-associated pneumonias / Number of ventilator-days) X 1000
** Source: National Nosocomial Infections Surveillance(NNIS) System Report, October 2004
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20
Reduction in VAP Rates –
National University Hospital, Singapore
Incidence of VAP in MSICU - 2000 to Q2 05
25.9
25
19.6
17.44
15
10
9.12 9.878.44 8.82
12.1
9.66 9.36
7.047.62
6.13
3.19
5
4.81
2.6
3.86
4.874.26 4.58
3
20
00
Q
4
20
00
Q
1
01
Q
2
01
Q
3
01
Q
4
01
Q
1
02
Q
2
02
Q
3
02
Q
4
02
Q
1
03
Q
2
03
Q
3
03
Q
4
03
Q
1
04
Q
2
04
Q
3
04
Q
4
04
Q
1
05
Q
2
05
0
Target ________
NNISClient
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20
Q
Per thousand ventilator days
30
Reduction of Complications at
“Istituto Giannina Gaslini” NI/PICU
30
27.2
25
20
15
10
5
4.9
3.6
2.6
0.9
0
0
2006
2007
*
Mortality (%) from hosp acq. Infections
** Hosp acq. Infections (per 1000 pt days)
*** Hosp acq. Pneumonia (per 1000 pt days)
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*
**
***
Improved Patient Safety
Patient Incidents per 100 Discharges
2.5
2
1.5
1
0.5
Ju
l
A
ug
Se
p
O
ct
N
ov
D
ec
Ja
n
Fe
b
M
ar
A
pr
M
ay
Ju
n
0
Indraprastha Apollo Hospital,
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New Delhi, India
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2005
2006
Unscheduled Returns to ICU Rates (Q1 2002 to Q4
2004) in National University Hospital, Singapore
Comparison With Project-Wide & S'pore Public Hospital Rates
12.0
10.34
10.0
8.0
8.09
8.01
7.95
6.63
4.63
4.77
5.35
4.26
5.67
4.68
4.05
4.0
2.0
4.35 4.09
3.99 3.68
4.54
4.23
3.82
3.80
3.41
1.47
1.88
Q204 Q304
Q404
3.66
3.50
3.39
3.47
3.64
3.66
3.44
3.47
3.65
3.57
3.11
0.0
Q102
Q202 Q302
NUH
Q402 Q103
Q203 Q303
S'pore Public Hospitals
Q403 Q104
Project-Wide
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5.61
6.0
7.61
Handwashing – Pt Safety
Trend on Hand Hygiene Compliace Rate in ICUs
100
95
95
95
JCAHO Benchmark
80
77
74
67
68.1
60
45.47
40
40.84
30.26
20
Desired
Outcome
64.12
0
Compliance
JCAHO Benchmark
20.34
38935
38966
38996
39027
39057
39089
39120
39148
39179
39209
20.34
30.26
45.47
40.84
63.22
64.12
67
74
68.1
77
95
95
95
95
95
95
95
95
95
95
n=250
n=250
n=100
n = No. of Observations
n=100
n=250
n=250
n=250
n=400
n=400
n=400
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% Compliance Rate
63.22
Apollo Hospitals
INDIA
touching lives
Patient Falls (%)
45
40
35
30
25
15
10
5
0
2004
2005
2006
2007
Indraprastha Apollo Hospital,
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New Delhi, India
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20
Laboratory Staff Safety
Hospital Clinica Biblica, Costa Rica
171
Q1
0
0
0
Q2
Q3
Q4
Preventable staff accidents 2007
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180
160
140
120
100
80
60
40
20
0
Needlestick Injuries –
Changi General Hospital, Singapore
No. of Needlestick Injury per 1000 CGH Healthcare Workers
8
5.96
5.93
6.25
6.13
3.45
4.29
4.80
2.85
2.92
2.88
2.97
2.80
2.45
2.99
2
2.36
1.88
1.72
1.74
2.48
2.39
2.98
1.19
2.36
1.17
2.29
1.87
0.59
1.20
0.00
0
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4
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5
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0.53
(CGH) No. of needlestick injury per 1000 CGH healthcare workers
Ju
n-0
5
Rate of Needlestick Injury
6
The rate of needlestick injuries per 1000 healthcare workers was reduced
from 7.91 in 2003 to 3.48 in 1st 6 months of 2005, an improvement of 127%
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So Far So Good
– One Middle East hospital embarked on a
study of the effect of the process, not of the
outcome, before and after JCI accreditation
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– These are individual reports, dealing
with segments of hospital operations –
Anecdotal accounts
– To study it systematically,
– 400 bed Government Hospital
– Accredited in 2007
– Studied before start of project to comply with
JCI standards
– Repeat study 15 months later (before survey)
– Perceptions of stakeholders studied by
questionnaires
– 100 point indices
Hassan, DK & Kanji, GK:
Measuring Quality Performance
in Healthcare 2007.
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Kingsham Press, Chichester, UK
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Study Details
Findings of Study
Main Areas of Improvement
Leadership & management
Quality improvement
Patient safety
Pt satisfaction & “delight”
Ethical performance
Documentation
Organizational learning
Organizational excellence
Areas of Lesser Improvement
Corporate structure
Human resources management
Staff satisfaction
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– All stakeholder groups reported improvement
in every dimension measured
– Overall improvement: 49% over baseline
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3rd Edition JCI hospital standards
support safe care for the global patient
JCI Standards Address Key Issues
Relevant to Medical Travel
Communication Issues (MCI)
 The patient and family are taught in a format and
language they understand.
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 The organization seeks to reduce physical,
language, cultural, and other barriers to access
and delivery of services.
JCI Standards Address Key Issues
Relevant to Medical Travel
 Care is considerate and respectful of the patient’s
values and beliefs.
 Care is respectful of the patient’s need for privacy.
 Patient information is confidential.
 Patient informed consent is obtained.
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Rights as Patients (PFR)
JCI Standards Address Key Issues
Relevant to Medical Travel
 Continuity and coordination are evident throughout
all phases of patient care.
 Referrals outside the organization are to specific
individuals and agencies in the patient’s home
community.
 A copy of the discharge summary is provided to
the practitioner responsible for the patient’s
continuing or follow-up care.
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Continuity of Care (ACC)
JCI Standards Address Key Issues
Relevant to Medical Travel
Truth in admission policies (ACC)
 At admission patients and families are provided
information on the proposed care, expected
results of care, and expected costs.
 The organization has established and
implemented a framework for ethical
management.
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 Patients are admitted for care only if the
organization can provide the necessary services
and settings for care.
JCI Standards Address Key Issues
Relevant to Medical Travel
 The organization has an effective process to
authorize all medical staff members to admit and
treat patients and provide other clinical services
consistent with their qualifications.
 The credentials of medical staff members are
reevaluated at least every three years to
determine their qualifications to continue to
provide patient care services in the organization.
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Professional Competence (SQE)
JCI Standards Address Key Issues
Relevant to Medical Travel
 The organization monitors its clinical and
managerial structures, processes, and outcomes
including:
Laboratory and radiation safety and quality
Surgical procedures
Use of antibiotics and other medications
Use of blood and blood products’
Infections
And 13 other areas including patient safety
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Evidence of quality (QPS)
JCI Standards Address Key Issues
Relevant to Medical Travel
Complaints (PFR)
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 The organization informs patients and
families about its process to receive and
act on complaints, conflicts, and
differences of opinion about patient care.
– There are many drivers for quality
evaluation however, patient safety is
one of the strongest
– The accreditation process is an
investment in the long-term health of an
organization
– The patients who live next to your
hospital are just as important as those
who cross borders to reach you
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Conclusions
Xie Xie
Do jeh Tak
tesekkür
ederim
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Grazie.
[email protected]
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www.jointcommissioninternational.org