Hospital Accreditation in Taiwan --- Challenge and Solution Dr. Wui-Chiang Lee, MD, PhD Director-general, Department of Medical Affairs, Ministry of Health and Welfare, Taiwan Former CEO, Taiwan Joint Commission on Hospital Accreditation President, Asian Society for Quality in Healthcare 1 Agenda The development of hospital accreditation in Taiwan Evolution of standards Impacts of hospital Accreditation Solution: Accreditation 4.0 Conclusions 李偉強博士 2 Hospital Accreditation Launched in 1978 Year 1951 1958 1974 1978 1989 1990 1994 1995 1996 1997 1998 1999 2000 2001 Country USA Canada Australia Taiwan New Zealand, China UK South Africa Finland, Korea, Indonesia Argentina, Spain Czech Republic, Japan Brazil, Poland, Switzerland France, Malaysia, Netherlands, Thailand, Zambia Portugal, Philippines Germany, Italy, Ireland 李偉強博士 3 3 Driving Forces of Accreditation Reform Hospital Community Development Epidemic crisis Risk Management Changes in Disease patterns Medical Error Patient Safety 李偉強博士 4 Continuous Quality Improvement PLAN Efficient PLAN PLAN Safe DO Equal Patient- Timely s centered ACT Effective CHECK 李偉強博士 5 Accreditation 1.0 (1978~1987) Teaching hospital accreditation By Ministry of Education and Department of Health Ensuring clinical education environment, hardware and faculty Once every two years Hospital classifications Level 1, 2, 3 Teaching hospital 李偉強博士 6 Accreditation 2.0 (1988~1998) Medical Care Act (1986) by the Department of Health Focus：hospital infrastructure, manpower, medical specialties，teaching and research capabilities Hospital Classification: Medical Centre District Hospital District Teaching Hospital Specialty Teaching Hospital 李偉強博士 7 Hospital Classification by Accreditation Linked to NHI Reimbursement 191 8 Medical Center 4 Regional Hospital 1 2 3 District Hospital 李偉強博士 8 The Main Criteria of Hospital Classification Hospital Structure Professional discipline Human resources Clinical teaching facilities and capability Clinical and basic research capacity Care process, outcomes and continuous improvement Patient safety and risk management Effective administration Emergency/critical/cancer care 李偉強博士 9 Accreditation 3.0 (1999 ~) TJCHA was established and entrusted to conduct accreditation since 1999 A 3~4 year cycle Apply and pay for accreditation Grant accreditation Report Contract out Surveyor Accreditation Processes TJCHA 李偉強博士 10 Objectives Patient-centered medical services and management Assuring quality and safety care Addressing risk management Patient right Infection control Continuous quality improvement Teaching and research capabilities As a reference for national health insurance reimbursement 李偉強博士 11 Characteristics Semi-voluntary participation Linked to health insurance contract and reimbursement Uniform accreditation standard (optional for different scale hospitals) Granted by Medical Care Law Run by 3rd party, supervised by Government (DOH) A 4-year cycle Self-assessment plus on-site survey 1~2.5 days (depending on hospital size) Charge (by hospital size) Results are released to the public 李偉強博士 12 Taiwan Joint Commission on Hospital Accreditation quality contest (HQIC) ● measurement system (TCPI) ● promotion of quality improvement tools (PDCA、RCA, TRM ) ● Accreditation & Certification Patient Safety (PS) Program QI Activities TJCHA Disease Prevention & Health Promotion Education hospital, psychiatric hospital, teaching hospital ● psychiatric rehabilitation institution, psychiatric nursing home ● infection control, hand hygiene, IRB, Chinese Medicine ● Emergent and Critical Care Ability Classification, Special Care Center, Disease-Specific Care, Health Check-up Program ● healthcare professional training programs ● PS reporting ● PS culture survey ● ● ● PS goals PS awareness week health promotion in schools and pharmacies Publication Journal, teaching guide, textbooks ● train the trainer ● healthcare faculty ●surveyors 李偉強博士 13 International Recognition as a Professional Accreditation Body International Society for Quality in Healthcare (ISQua) Accreditation Organization since 2006 Accreditation Standards since 2007 2013~2014 李偉強博士 14 Evolution of Accreditation Standards 李偉強博士 15 Characteristics Semi-voluntary participation Linked to health insurance contract and reimbursement Uniform accreditation standard (optional for different scale hospitals) Granted by Medical Care Law Run by 3rd party, supervised by Government (DOH) A 4-year cycle Self-assessment plus on-site survey 1~2.5 days (depending on hospital size) Charge (by hospital size) Results are released to the public 李偉強博士 16 Evolution of Accreditation Standards 2011 Year 2005 Hospital Accreditation Standards (2007~2010) Old Hospital Accreditation Standards (~2006) Hospital Management 1. Vision、Strategies and Community Functions Administrative management Medical Care 2. Management and Operations Surgery 3. Patient Rights and Safety Internal medicine 4. Healthcare Systems and operations Nursing 5. Appropriate Healthcare Operations Pharmaceutical 6. Appropriate Nursing Care Radiation 7. Comfortable Healthcare Environment and Care Clinical laboratory (transfusion) and pathology (add in 1990) 8. Human Resources and Quality Improvement Psychology(add in 1991) Emergency medicine(add in 1993) Infection control(add in 1996) 2 surveyor teams (administrative, medical care) 3 surveyor teams (administrative, medical, nursing) 10 Surveyor teams 李偉強博士 17 Hospital Accreditation Standards – Management PLAN 1.1 Management strategy 1.2 Staff management and support system ACT DO 1.3 Human resources management 1.4 Employee education and training CHECK 1.5 Medical records & information management 1.6 Safe environment and equipment 1.7 Patient-oriented services 1.8 Crisis management and disaster response 18 李偉強博士 Hospital Accreditation Standards – Medical Care 2.1 Patient rights 2.2 Health care quality management 2.3 General medical care/safety 2.4 Specialized medical care/safety ER, ICU, psychiatric, dialysis, respiratory care 2.5 Medication safety 2.6 Anesthesia and surgical safety 2.7 Infection control and antibiotic use 2.8 Lab work, pathology and radiology safety 2.9 Continuous care after discharge 19 李偉強博士 Computerized Accreditation System 李偉強博士 20 Survey Methods Self-assessment On-site survey Quality measurement and improvement (PDCA survey) Patient-focused methodology (PFM) 李偉強博士 21 PDCA and Grading Scales grade C grade A grade B 李偉強博士 22 Quality Improvement Activities and Statistics 門診候藥時間及滿意度分析-2 自97年10月30日起嚴控>25分鐘立即寫檢討報告 100 15.2 90 15 76.0 分鐘( min ) 14 63.4 13 12 11 10 9 8 成效卓著： 9.8 1.大於25分鐘次數每日<1人次(改善99%) 2.平均候藥時間縮短5.4分鐘(改善36%) 3.滿意度總排名由第8名進步為第2名 96上 96下 97上 97下 98上 98下 80 70 60 50 40 30 20 10 0 百分比( % ) 16 99上 Results：more than 25min daily＜1人次(improved 99 ％)。Average time shortened 5.4min (improved 36％)。 Satisfaction ranking from No.8 to No. 2 平均候藥時間(min) 候藥時間滿意度 (%) 1. Acute MI patients complete EKG 10min within reaching hospital. Rate increased from 13%-66.7% 2. D2B time dropped from 164min – 79min. Results: Error：2010 2cases(0.0024%)，2009 (3 cases)dropped 33%， Repeat application ：2010 82 cases (0.1022%)，2009 (116件) dropped 29%。 1.77% aids patient draw blood within 15min 2.Waiting time approximately 9min。 3.Peak hour（8:00-8:30AM）approximately wait 17min。 4.non-peak hour approximately wait 5-14min 李偉強博士 23 Patient-Focused Methodology 李偉強博士 Public Disclosure of Accreditation Results www.mohw.gov.tw Basic information（beds, manpower etc.) Service information（out/inpatient volume, financial reports) Granted accreditation level Teaching capability for different medical disciplines 李偉強博士 25 Impacts of Hospital Accreditation 李偉強博士 26 High Participation Rate Resources: ISQua Conference 2011, Hong Kong李偉強博士 27 Reasonable Cost Every 100 bed evaluation cost（unit：US$） Resources: ISQua Conference 2011, Hong Kong李偉強博士 28 Positive Influences A nationwide and systemic review of all hospitals by an uniform quality and safety standard Improvement of hospital infrastructure Standardization of the processes of medical services Patient right protection Build teaching standards and training professionals Enhance popularity and competitiveness amongst peers 李偉強博士 Improvement in Critical and Acute Care ICU overall return rate of 7% (2000) has been reduced to 5.67% (2011) ICU central venous catheter bloodstream infection rate dropped from 5.7 ‰ 3.2 ‰ Cardiovascular disease care in the hospital with acute myocardial infarction patients execution of(Door-toballoon) within 90min was up to 92% 李偉強博士 30 Intangible Influences Strengthening teamwork and honor Enhancing positive attitudes toward quality and patient safety culture Enhancing sense of crisis management Humility 李偉強博士 Positive Influence on Safety Culture 55 50 Teamwork 45 40 Safety Climate 35 Job Satisfaction 30 Perception of Management 25 20 15 Working Conditions After accreditation Before 10 A-1 A0 A1 A2 李偉強博士 32 Benefits for Patients To ensure appropriate level of quality and safety care for all hospitals To be respected (informed consents) Patient right and privacy are protected More user-friendly environment Empowerment 李偉強博士 33 Accreditation 4.0 李偉強博士 34 Unintended Consequences Too much emphasis on ranking and scores, competitiveness replaced cooperation Reimbursement linked to accreditation, resources allocate to urban and large-scale hospitals Parts of the requirements are too difficult to achieve Paperwork and extra workload Shortage of nurses and critical care doctors, and overloading employees Revenue cannot afford accreditation requirement and hospitals were downsized or to be merged 李偉強博士 35 Patient and Employees are Equally Important Studies have shown when medical personnel were exhausted, quality and safety of care will slip When lacking staff, any ideal evaluation cannot be implemented Considering the situation of payment, manpower and workload must be adjusted “There is no free lunch” Hospital has the responsibility to ensure labor conditions NHI reimbursement should reflect quality and cost 李偉強博士 36 Quality Measurement and PDCA Most commonly applied quality indicator system in Taiwan: • Taiwan Clinical Performance Indicator (TCPI) • Taiwan Healthcare Indicator Series (THIS) • Taiwan Community Hospital Association (TCHA) 1. Acute MI patients complete EKG 10min within reaching hospital. Rate increased from 13%-66.7% 2. D2B time dropped from 164min – 79min. 1.77% aids patient draw blood within 15min 2.Waiting time approximately 9min。 3.Peak hour（8:00-8:30AM）approximately wait 17min。 4.non-peak hour approximately wait 5-14min 李偉強博士 37 Taiwan Clinical Performance Index (TCPI) TJCHA TCPI indicators 李偉強博士 Toward One System, Continuous Measurement NHI quality-based reimbursement National Quality Core Indicators External auditing /Public disclosure Hospital internal surveillance & quality improvement 李偉強博士 39 Continuous Surveillance Public Sector Data imported Policy Reference Monitoring System Data provided Hospital Evaluation reference Help discover problems/ Provide interior improvement Surveyors 李偉強博士 40 Knowledge Management System 李偉強博士 41 Accreditation 4.0 Continuous quality evaluation Quality reporting Real-time survey Performance evaluation Feedback & Comments Accreditation PDCA On-site survey Individual and systematic tracer 李偉強博士 42 Integrating Standards into Practices Non-accreditation period Continuous quality measurement and report Online assessment and feedback by experts Ad hoc inspection for safety events or significant variations in performance On-site accreditation (4-year cycle) Document reviewing as less as possible Patient-focused methodology Emphasis on abnormal management and system 李偉強博士 43 Conclusions Taiwan’s hospital accreditation has played important roles in each stage of hospital development for the past 35 years in a row. Although some unintended consequences exist, accreditation indeed improves the quality of care in infrastructure and processes of medical services To address process and outcome of care The Taiwan model can share with many countries who wish to have its own accreditation system at affordable cost 李偉強博士 44 We Need to Work Together! 李偉強博士 45 [email protected]
© Copyright 2024 ExpyDoc
