Hospital Accreditation
Setting Standards
Kigali, Rwanda
DATE
Dr. Bonaventure NZEYIMANA
Ministry of Health
nzeyimana.bonaventure68@gmail.com
Tel: (+250) 788585815
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 Force
5. Review the JCI “Essentials”.
2
What is quality?
Definition of quality
“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.”
Rwanda MOH, 2012
Dimensions of quality
Professional Competence
Technical performance
Access to services
Effectiveness of care
Efficiency of service delivery
Interpersonal communication
Continuity of services
Safety
Physical infrastructure
Choice of services
Coverage & utilization
Definition of quality assurance
“That set of activities which defines norms,
measures and improves performance of
healthcare services, such that healthcare is
as effective and as safe as possible.”
Rwanda Ministry of Health
August 2008
SYSTEMIC VISION
Inputs
Processes
Outcomes
Personnel: (HRH strategic
plan with emphasis on
specialized personnel)
Equipment: Modern
equipment for referral
hospitals
Supplies: Quality control
for all supplies and
consumables
Admission: Improved by
standards
Test Procedures: 238
policies, procedures
and guidelines
Patient Education: for the
prevention and CHWs
play major role
Treatment: Treatment
guidelines developed
and disseminated
Improved health
status
Efficient services
Vaccination Coverage in Rwanda
100%
80%
BCG
DTP (3)
60%
Measles
Polio (3)
40%
20%
0%
1990
1995
2000
2005
Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for Rwanda.
2010
8
9
Child Mortality in Rwanda, 1990 – 2011
300
275
Rwanda
Sub-Saharan Africa
250
200
World
183
178
170
154
Probability of child
dying by age 5 per 150 156
1,000 live births
133
108
112 109
100
87
82
50
73
60
63
54
53 51
59
52
29
0
1990
1995
2000
2005
2010
2015
MDG Target
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 Rwanda
Timeframe
Decline 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%
Cause
Non Communicable
diseases
????
Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons
10
from Success.” British Medical Journal 346(f65): [e-pub ahead of print].
Defining Quality
QA
Improving
Quality
Measuring
Quality
Quality Assurance Project
Rwandan Model to Quality Care
Improvement
1. Accreditation
2. Universal Coverage
3. PBF
Quality 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%)
Accreditation
14
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?
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
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