Hospital Accreditation Setting Standards

Dr. Bonaventure NZEYIMANAMinistry of Health

nzeyimana.bonaventure68@gmail.comTel: (+250) 788585815

Kigali, RwandaDATE

Session Objectives

1. Identify the benefits of accreditation.2. Recognize the importance of standards in

improving performance.3. Review quality concepts that provide the

framework for standards development.4. Describe the terms of reference of the

Standards Task Force5. Review the JCI “Essentials”.

2

What is quality?

Definition of quality

Rwanda MOH, 2012

“The correct implementation of health interventions according to established norms and procedures, which satisfy the health system’s clients and maximize health outcomes without creating health risks or unnecessary costs.”

Technical performance

Access to services

Effectiveness of care

Continuity of services

Interpersonal communication

Efficiency of service delivery

Safety

Physical infrastructure

Choice of services

Dimensions of qualityProfessional Competence

Coverage & utilization

Rwanda Ministry of Health August 2008

“That set of activities which defines norms, measures and improves performance ofhealthcare services, such that healthcare isas effective and as safe as possible.”

Definition of quality assurance

SYSTEMIC VISION

Inputs Processes Outcomes

Personnel: Personnel: (HRH strategic (HRH strategic plan with emphasis on plan with emphasis on specialized personnel)specialized personnel)

Equipment: Equipment: Modern Modern equipment for referral equipment for referral hospitalshospitals

Supplies: Supplies: Quality control Quality control for all supplies and for all supplies and consumablesconsumables

Admission: Admission: Improved by Improved by standardsstandards

Test Procedures: Test Procedures: 238 238 policies, procedures policies, procedures and guidelinesand guidelines

Patient Education: Patient Education: for the for the prevention and CHWs prevention and CHWs play major roleplay major role

Treatment: Treatment: Treatment Treatment guidelines developed guidelines developed and disseminatedand disseminated

Improved health Improved health statusstatus

Efficient servicesEfficient services

8Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for Rwanda.

87 8273

6353 51

156

275

183

108

6054

178170

154

133

112109

29

5259

Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print].

9

10

CauseTimefram

eDecline in Mortality

Malaria (reported deaths)

2005 – 11 85.3%

HIV/AIDS (rate) 2000 – 09 78.4%

Tuberculosis (rate) 2000 – 10 77.1%

Child mortality (rate) 2000 – 11 70.4%

Maternal mortality (ratio)

2000 – 10 60.0%

All-cause mortality (rate)

2000 – 10 50.0%

Non Communicable diseases

????Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print].

Towards reducing premature death in RwandaTowards reducing premature death in Rwanda

Quality Assurance Project

Defining Quality

QA

Measuring Quality

Improving Quality

Rwandan Model to Quality Care Improvement

1. Accreditation2. Universal Coverage3. PBF

Quality ImprovementQuality Improvement• Standards, Policies, procedures and Treatment, Guidelines in all

hospitals (2012)• Accreditation of KFH (97% in 2013)

• External evaluations for CHUK and CHUB– 37% in 2007, 40% in 2009 and 55% in 2011 for CHUK – 27% in 2007 and 40% in 2012 for CHUB

• Baseline Assessment conducted in 4 Provincial Hospitals, under process for District Hospitals

• Norms infrastructure, equipment and Human Resources• Customer care: Patients rights, 114 free call, suggestion boxes,

quarterly evaluation

• Improved supply chain management (06/2012- 03/2013: DH; 78-98%, DP; 87-95%, RH; 76-94%)

14

Accreditation

Definition of Accreditation

A process in which an entity, separate and distinct from the hospital, usually nongovernmental, assesses the hospital to determine if it meets a set of standards designed to improve quality and safety of care

Accreditation - Does it make a difference?

Accredited hospitals report significant improvements in:– Leadership– Medical records management – Infection control– Reduction in medication errors– Staff training and professional credentialing– Clinical outcomes

Does it make a difference?Does it make a difference?

Current Progress

• National Referral Hospitals: COHSASA (Council For Health Service Accreditation of South Africa) accredited by ISQUA curry external evaluation (against International standards)

• District Hospitals: JCI, accredited by ISQUA is conducting the external assessment. (Rwanda Essentials of Healthcare Quality and Safety).

• Health centers and Private Health sector: will join the process in 2016.

Rwanda Essentials of Healthcare Quality and Safety

Five Risk Areas– Leadership– Competent workforce– Safe environment– Clinical care– Quality improvement