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QUALITY AND ACCREDITATION A DIRECT LINK? UBUZIMA BURAMBYE PROGRAM Ministry of Health RWANDA QUALITY AND ACCREDITATION A DIRECT LINK? UBUZIMA BURAMBYE PROGRAM Ministry of Health RWANDA

Accreditation, in short …. • Accreditation is defined in the British Medical Journal as Accreditation, in short …. • Accreditation is defined in the British Medical Journal as "A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve". L’accreditation, la créditation, l’âcre-éditation? ? ? 2

What is Hospital Accreditation ? • Mechanisms for recognition of institutional competence • By What is Hospital Accreditation ? • Mechanisms for recognition of institutional competence • By an independent accrediting body (Usually) • Applying hospital standards for optimal and achievable performance • Hospital survey by external peer reviewers • Voluntary participation (Usually) • Emphasis on continuous quality improvement

Hospital accreditation as a regulatory incentive • • Improve quality of health care • Hospital accreditation as a regulatory incentive • • Improve quality of health care • Patient safety and risk management • Evidence-based practice • Continuous learning and improvement Stimulate and improve integration and management of health services Reduce variation in care and health care costs Strengthen the public’s confidence in the quality of health care

Policy Orientation - Rwanda • Vision: To provide quality and safe healthcare services meeting Policy Orientation - Rwanda • Vision: To provide quality and safe healthcare services meeting international standards, to ensure a healthy population for a wealthy nation. • Mission: To continuously improve delivery of safe, quality healthcare services provided to the public in collaboration with our stakeholders through quality improvement approaches and evidence-based standards towards accreditation. • Goals: To provide high quality and safe health care services to the population of Rwanda 5

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Mo. H Quality Assurance Triangle Dvp Standards, Clinical Guidelines, Policies and Procedures, etc. Defining Mo. H Quality Assurance Triangle Dvp Standards, Clinical Guidelines, Policies and Procedures, etc. Defining Quality QD Accreditation Facilitation Improving Quality QI Quality Measuring Quality QM 7 Selfassessment & External assessment

Rwanda experience • MOH identified five “risk areas” on which to focus initial quality Rwanda experience • MOH identified five “risk areas” on which to focus initial quality and safety improvement efforts: • • • RA 1: Leadership RA 2: Competent Workforce RA 3: Safe environment RA 4: Clinical Care RA 5: Quality and Safety • Core standards= Addressing systems, processes, policies and procedures • Critical standards= Required by National Laws & Regulations 8

Levels of effort • “Levels of Effort” are identified for each standard provide a Levels of effort • “Levels of Effort” are identified for each standard provide a means for evaluating progress in reducing risk and improving quality. • The Levels of Effort that represent progressive achievement in reaching the expectations found in a standard: • At Level 0, the desired activity is absent, or inconsistent activity related to risk reduction. • At Level 1, the policies, procedures and plans are in place to address the risk. • At Level 2, the processes are in place for consistent and effective risk reduction activities. • At Level 3, there are data to confirm successful risk-reduction strategies and continued improvement 9

Scoring system LEVEL III AVERAGE SCORE RISK AREA ≥ 75% ≥ 70 % ≥ Scoring system LEVEL III AVERAGE SCORE RISK AREA ≥ 75% ≥ 70 % ≥ 60% OVERALL AVERAGE SCORE ≥ 85% ≥ 70% 80% 100% CRITICAL STANDARD MET 10

Example STANDARD #6 Diagnostic imaging services available, safe, and reliable RISK LINK Patients are Example STANDARD #6 Diagnostic imaging services available, safe, and reliable RISK LINK Patients are at risk when their assessment requires diagnostic imaging services and the services are not available within or outside the organization, or are not provided safely LEVELS OF EFFORT Level 0: Diagnostic imaging services are not consistently available and reliable to meet patient needs and/or there is no radiation safety program. Level 1: Current radiology policies, procedures and safety manual are available. Level 2: Diagnostic imaging services are consistently available to meet patient needs, the radiation safety program meets all legal requirements, and the tests are conducted and reported by qualified individuals in a timely manner. Level 3: Diagnostic imaging quality control is performed for imaging tests and oversight is provided for tests performed outside the radiology department; data are used to improve accuracy of results. 11

Performance of 6 Hospitals Towards Meeting Critical Standards Q 4 2015 Performance of 6 Hospitals Towards Meeting Critical Standards Q 4 2015

Accreditation and quality? - institutional + norms and standards + High level ownership and Accreditation and quality? - institutional + norms and standards + High level ownership and accreditation high on MOH agenda + Quality improvement culture - Another vertical program? - No neutral agency yet - MOH led process so far ( role status, funding, scope, composition tbd) - Reference for the norms and standards: international vs local context - Budget availability not confirmed - High cost in human and financial resources - Terminology: accreditation and quality terms too often interchanged 13

Accreditation and quality? - organizational + Revitalization of Q committees at hospital levels + Accreditation and quality? - organizational + Revitalization of Q committees at hospital levels + Quality high on agenda at facility level + Accreditation linked to PBF - High burden on the hospital staff - Numerous committees - Initial process very bureaucratic (checklist approach) – three days assessment minimum - No involvement of health insurances yet 14

Accreditation and quality? - individual + Potential with Initial targets on nosocomial infections, customer Accreditation and quality? - individual + Potential with Initial targets on nosocomial infections, customer care, incident management + Patient flow? - Process in place ≠ automatic Change in quality? – to be confirmed 15

Process = signposts Output = getting where planned outcome = treated and better 16 Process = signposts Output = getting where planned outcome = treated and better 16

Some Challenges § Definition of standards § Heavy and top down § Cost and Some Challenges § Definition of standards § Heavy and top down § Cost and sustainability § Independent Healthcare Accreditation Organization

Next steps § Establishment RHAO § Development of PHC/HCs standards in June 2016 § Next steps § Establishment RHAO § Development of PHC/HCs standards in June 2016 § Engage private health facilities into accreditation program § Engaging health insurances schemes to accreditation § Advocacy for financial support

? Approach: through quality improvement approaches towards accreditation Vs through accreditation approach towards quality ? Approach: through quality improvement approaches towards accreditation Vs through accreditation approach towards quality improvement 19

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