Building Public/Private Partnership
for Health System Strengthening
“Thai Experience with Hospital
Accreditation”
Assoc. Prof. Jiruth Sriratanaban, M.D., Ph.D.
Dept. of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn
University
Bali Hyatt Hotel, Sanur, Bali
21-25 June 2010
Thailand’s Health system
Development of Hospital Accreditation
(HA) in Thailand
Hospital accreditation as a mechanism to
regulate health care system and to
promote public-private partnership
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Population: 67 Million
Rural: Urban Pop. =
Top 3 killers:
Health exp. As % of GDP: 3.3-3.5%
Universal coverage: three compulsory public
schemes, i.e. CSMBS, SSS and NHSS (UC)
Public: Private exp. on health = 60:40
Groups of hospitals
Number
Public hospitals (2007) :
MOPH Community hospitals
Total
982
730
MOPH General hospitals
70
MOPH Tertiary-care regional hospitals
25
MOPH Specialized hospitals in provinces (except BKK)
47
Other public hospitals in provinces (except BKK)
60
University / Medical-school hospitals
10
MOPH Tertiary-care hospitals / specialized institutions in BKK
18
Other public hospitals (e.g. Police, Military, BMA, etc.)
22
Private hospitals (2006) :
344
Private hospitals in BKK
102
Private hospitals in provinces (except BKK)
242
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Inequity due to mal-distribution of health resources
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Increasing health care expenditure
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Introduction of close-ended payment
mechanisms by the major health
security schemes
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Expansions of business health sectors
and the governmental “Medical hub”
policies
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Increasing trend of patient complaints and lawsuits
Threats
against
quality of
health care
Thailand’s Health system
Development of Hospital Accreditation
(HA) in Thailand
Hospital accreditation as a mechanism to
regulate health care system and to
promote public-private partnership
Initiated as a research and development project in 1997
under the Health System Research Institute (HSRI) with
financial support from WHO, TRF and HSRI of Thailand
35 pilot public and private hospitals
Adapted Canadian approach (+ External consultant)
Collaboration for Hospital Quality Improvement and
Accreditation
Developed into “Institute for Hospital Quality
Improvement and Accreditation” under HSRI
Become “Healthcare Accreditation
(Public organization)” since 2009
Institute
Accredit the hospital quality
Accredit the hospital quality system
Mechanisms to stimulate and facilitate hospitals to
improve quality in an organization-wide and
systematic manner
Plan
Do
Quality
hospital
Act
Check
CQI
Accredit
Hospital
Accredit
QA/
Standard
RM
First version of HA Standards
Structure / Input
GOV Governance
LED Leadership
GEN 1 Goals & directions
GEN 2 Organization &
management
Process
IC Infection
control
Outcome
IM Information /
Medical record
GEN 8 Patient care &
Service processes
Patient
Outcome
ETH Patient rights &
organizational ethics
GEN 3 Human resources
GEN 4 management and
HUM development
GEN 5 Policy & procedures
GEN 6 Facilities &
ENV environment
GEN 7 Equipment
GEN 9 Quality programs
e.g. RM, QA, CQI
MED Medical staff organization
NUR Nursing administration
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Health needs and
customers’ expectations
Governance and policy directions
[1], [2]
Resource management
[3], [4], [5], [6], [7]
Professional systems,
patient rights and
organizational ethics
[11], [12], [13], [14],
Input
Patient care process and services
[10], [15], [16], [17], [18], [19], [20]
Analysis, measurement
and improvement
[8], [9]
Output
Patients and other customers
Health outcomes,
Satisfaction
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Information and knowledge management
Part IV
Staff focus
Strategic planning
Leadership
Results
Focus on patients
And Patient rights Part I
Process
management
Health care
Patient and customer
Financial
Human resources
Organization effectiveness
Leadership and Social
Health Promotion
MBNQA/TQA Model
Key hospital systems Part II
Hospital and
Health care
services
Standards
2006
Risk, Safety and Quality
Professional management
Environmental management
Infection prevention and control
Medical record system
Medication system
Medical laboratory system
Radiological system
Work with communities
Patient care processes
Part III
Patient care processes
Entry
Patient Assessment
Planning (Care & Discharge)
Care Delivery
Patient & Family Empowerment
Continuity of Care
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Selection and training of peer reviewers or
surveyors
Supervision and ongoing education of surveyors
Education and consultation about the standards to
health care organizations
Pre-survey processes
Development of a standardized evaluation
methodology to assess standards performance
On-site surveys (10-15,000 baht per man-day)
Surveyor documentation and scoring
Post-survey analysis of surveyor findings
Hospitals improve quality
according to standards
Hospitals complete
HA self-assessment
Intensive consultation visit
(ICV)
Accreditation survey
Accreditation decision by HA Board
Training programs
Manuals, documents,
books, websites
Support networks
Consultations
National forums
Example of Roadmap to HA:
King Chulalongkorn Memorial Hospital
Commitment and common direction
1999
Team / Staff / Supporting facilities
Pilot new activities / Expand the existing
Improve core processes
Expand to the whole organization
Self assessment and internal survey
Fulfill to meet the hospital standards
2002
Request for accreditation survey
Improvement of
patient care processes
Patient care teams (PCT)
New protocols for informed consent
Comprehensive patient assessments
Applications of clinical practice
guidelines, critical paths, care map
Customized self-helped groups and
individual health promotion programs
Intensive prevention and control for
hospital-acquired infection
New Discharge planning programs
Example of results ...
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Average length of stay :
Shorter
28-day readmission rate : Decline
Hospital-acquired infection: Decline
Patient risk incidence :
Fewer serious
incidence
 Patient satisfaction :
Higher
 Waiting time :
Shorter
Accredited hospital means …
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Organization commitment on quality
improvement
Adequacy of health care resources with
efficient management
Existence of quality assurance and
continuous quality improvement
Existence of mechanisms to promote
professional standards and ethics
Service provision that protects patient rights
and promotes organization ethical practices
Quality patient care processes
400
Number of hos pitals
350
300
250
HA & HPH
200
HPH
HA
150
100
50
0
Jan-04
Jan-05
Jan-06
Jan-07
Thailand’s Health system
Development of Hospital Accreditation
(HA) in Thailand
Hospital accreditation as a mechanism to
regulate health care system and to
promote public-private partnership
Licensure system for private providers
Thai Medical Council standards
Quality improvement programs by MOPH
Standards for infrastructure, 3-S program,
TQM, ISO
The Social Security Office (1991)
Health Care Facilities Act, B.E. 2542
The Constitution of the country (1999 onward)
The National Health Security Scheme
Improve quality of health care using the
optimal set of hospital standards as guidelines
Patient safety and risk management
Evidence-based practice
Continuous learning and improvement
Stimulate and improve integration and
management of health services
Strengthen the public’s confidence
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Hospital accreditation is an education
process, not an inspection
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Let’s make it together
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Bring the professional organizations into
the field.
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Create opportunities for performancebased incentives
Web-based and
Paper-based
Supporting documents
External (Accreditation)
survey
On-site Process
benchmarking and
consultation
Meetings for
experience sharing
and training
Inter-hospital
Quality conference
2004
Hospitals
Staff
2005
Sites
Staff
2006
Sites
Staff
2007
Sites
Staff
Sites
Tertiarycare
189
11
267
10
204
12
346
17
General
753
58
746
51
676
48
890
52
Community
850
170
1527
223
1587
198
1997
280
University
(teaching)
525
18
583
16
607
18
336
21
Private
610
100
618
80
719
90
990
128
Military
193
28
175
12
212
22
300
28
Mental
86
8
71
7
100
9
98
10
3,206
393
3,987
399
4,105
397
4,957
536
Total
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Policy formulation
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Standard writing
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Implementation of clinical practice
guidelines
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Accreditation decisions and recognition
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Linkage to professional training
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Social Security Scheme endorsement of HA
◦ Special quota of registered beneficiaries for
accredited providers
◦ Additional per-head payment for accredited hospitals
National Health Insurance Scheme movement
◦ Financial support for HA consultation programs
◦ Financial bonus for accredited providers
Impacts for national health service systems
◦ Health promoting hospital
◦ Use of evidence-based practice
◦ Disease management programs by NHSO
◦ Humanized health care initiatives
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Is there an opportunity to use a
hospital accreditation program to
promote public-private partnership?
How can a hospital accreditation
program support a system policy on
public-private partnership?
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Promote standardized requirements for optimal
hospital performance
Create environment for partnership
◦ Platform in policy formulation
◦ Public-private co-operation in improving care
◦ Knowledge sharing activities
 Ensure quality and strengthen public confidence
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