Dr. John Helfrick answers “Five Questions” on hospital quality
We know that increasing numbers of patients around the world are traveling outside their own country for health care, whether they’re looking for better quality, affordability, or both. An entire industry is growing out of the need to connect patients with faraway providers, manage travel and logisitics, and ensure that patients’ experiences abroad are satisfactory. One of the big questions raised by skeptics of “medical tourism” is this: how is one to assess the quality of hospitals abroad?
In recent years, accreditation by Joint Commission International has served as a kind of stamp of approval that patients look for when considering foreign providers. But JCI accreditation — like accreditation by the Joint Commission (formerly JCAHO) — isn’t really a measure of clinical quality. What it is, says PHMI Senior Consultant Dr. John Helfrick, is an indication that a hospital has the systems and processes in place to support high-quality, safe patient care:
“Accreditation” is generally not well understood. It is a process, not an event. There is a “validation” survey but it’s the maintenance of good processes and the improvement of deficient ones that occurs between surveys that really constitutes accreditation. Most “accreditationists” believe that health care outcomes are dependent on the quality of the structures and processes in place in a health care organization. The accreditation process is designed to assist organizations in implementing and then improving their structures and processes. The effectiveness of this process is borne out by the measurement of and, hopefully, the improvement in the outcomes of care.
In recent years PHMI has worked with several health care organizations who have used the JCI accreditation process as a guide for instituting a culture of quality. The process provides a roadmap that helps the provider to develop the kinds of structures they need to produce good outcomes. And while the distinction of earning JCI accreditation can be used as a marketing tool for as long as it is viewed as an indicator of attention to quality care, most clients believe that the process of earning accreditation is most important. From Dr. Helfrick:
Some hospitals pursue accreditation to give themselves a marketing advantage; others do it for the right reason. Interestingly, it’s this latter group that has the most effective marketing approach: commit to high-quality, safe care, and the patients will come. Hospitals that go through the triennial cycle once and then drop out have most likely become accredited for the wrong reason.
Read what else Dr. Helfrick has to say about hospital quality improvement in the July-August issue of PHMI WORLD.
“There is a “validation” survey but it’s the maintenance of good processes and the improvement of deficient ones that occurs between surveys that really constitutes accreditation”
Process is based on the work of others before who made discoveries and produced them. The flow of those outcomes is our due process. When we produce our own outside that process it is to be measured on stand alone project basis - without the process being seen. Often the two systems are mixed indiscriminately causing much wastage to the public. Following due process is faith based. Producing new outcomes is confirmation of independence.
I agree [with the original post]. Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. The objective is not to cram for, and get a “passing” grade on the triennial Survey, it is to develop a “world class” quality management foundation that includes:
Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.
Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables “real time” information.
Process: including concurrent intervention, the ability to identify key quality performance “gaps,” and performance improvement tools and methodologies to effectively eliminate quality issues.
Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay “survey ready every day.”
Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.
My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.