International Healthcare Accreditation - Healthcare and Hospital Accreditation

Healthcare and Hospital Accreditation

Fundamentally healthcare and hospital accreditation is about improving how care is delivered to patients and the quality of the care they receive. Accreditation has been defined as "A self-assessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve" Interest in hospital accreditation ascends as far as the World Health Organisation (see external links). Accreditation is one important component in patient safety. However, there is limited and contested evidence supporting the effectiveness of accreditation programs.

In the USA in the early 20th century, there was concern over how to best create an appropriate environment in which clinicians could work. Standards to improve the control of the hospital environment were thus generated, and these subsequently grew into accreditation schemes with the remit to facilitate and improve organisational development. Part of the process is not only about assessing quality, but also about promoting and improving quality. Similar accreditation schemes were soon developed elsewhere in the world.

In countries such as the United Kingdom, the USA, Australia, New Zealand and Canada, sophisticated accreditation groups have grown up to survey hospitals (and, in some cases, healthcare in the community). Furthermore, other accreditation groups have been set up with openly declared remits to look after just one particular area of healthcare, such as laboratory medicine or psychiatric services or sexual health.

Accreditation systems are structured so as to provide objective measures for the external evaluation of quality and quality management. Accreditation schemes should ideally focus primarily on the patient and their pathway through the healthcare system – this includes how they access care, how they are cared for after discharge from hospital, and the quality of the services provided for them. At the heart of these schemes is a list of standards which, ideally, serve to assess evaluate in a systematic and comprehensive way the standards of professional performance in a hospital. This includes not only hand-on patient care but also training and education of staff, credentials, clinical governance and audit, research activity, ethical standards etc. The standards can also be used internally by hospitals to develop and improve their quality standards and quality management. Some international accreditation schemes believe that the standards applied should be fixed and are non-negotiable, while others operate a system of negotiation over standards - however, whatever approach is taken the every aspect of the process should be evidence-based.

International standardization groups also exist, but it must be pointed out that the mere achieving of set standards is not the only factor involved in quality accreditation - there is also the significant matter of the incorporating into participating hospitals systems of self-examination, problem solving and self-improvement, and hence there is more to accreditation than following some sort of overall "standardization" process.

As governments and the general public have increasingly come to demand more and more openness about health care and its delivery, including and especially hospital quality and safety and the clinical performance of doctors, and these accreditation systems have generally adapted to fulfill this extended role.

However, accreditation should ideally be independent of governmental control, and accreditation groups should assess hospitals “holistically”, and not just some isolated facet of the hospital’s activities or services such as the laboratories, pharmacy services, infection control, financial health or information technology services (indeed, partial accreditation of this type should be publicly acknowledged as such by both the accreditation scheme and the hospital). The best accreditation schemes also assess academic and intellectual activity (such as teaching and research) within those hospitals that they survey (see later) and have a clear and declared interest in medical ethics.

In some parts of the world, accessing healthcare can be very expensive, even prohibitively so. While some countries have elected to provide comprehensive healthcare services for all of their populations, others appear to be satisfied with leaving portions of their population without access to healthcare. When it comes to who pays the bills for healthcare, it may be the government or it may be the individual (sometimes either by direct payment, and sometimes through employer-run schemes, insurance companies etc.), or a combination of both. However, healthcare can never be truly “free” – someone somewhere will always have to pay, and the payer will always want the best value for money possible. "Affordability" of healthcare can be the insurmountable hurdle for some human beings. Value for money is hence another factor in assessing the true quality of healthcare.