Impact of Arab Accreditation Project on Impact of Arab Accreditation Project on Patient SafetyPatient Safety

Arab Hospital Federation CongressArab Hospital Federation Congress

Sharm El Sheikh-EgyptSharm El Sheikh-Egypt 4-5 March,20084-5 March,2008

Dr.Safa El Qsoos/Quality DirectorDr.Safa El Qsoos/Quality DirectorMinistry of health/JordanMinistry of health/Jordan

AccreditationAccreditationProcess in which an entity, separate and Process in which an entity, separate and distinct from the health care organization, distinct from the health care organization, assesses the health care organization to assesses the health care organization to determine if it meets set of requirements determine if it meets set of requirements designed to improved the quality of care, designed to improved the quality of care, its usually voluntary and provides a visible its usually voluntary and provides a visible committement to improve quality of committement to improve quality of patient care, ensure a safe environment, patient care, ensure a safe environment, and continually work to reduce risks to and continually work to reduce risks to patients and staffpatients and staff

Accreditation historyAccreditation history

19101910

Ernest Codman, M.D., proposes the “end result Ernest Codman, M.D., proposes the “end result system of hospital standardization.”  Under this system of hospital standardization.”  Under this system, a hospital would track every patient it system, a hospital would track every patient it treated long enough to determine whether the treated long enough to determine whether the treatment was effective.  If the treatment was treatment was effective.  If the treatment was not effective, the hospital would then attempt to not effective, the hospital would then attempt to determine why, so that similar cases could be determine why, so that similar cases could be treated successfully in the future.treated successfully in the future.

19131913

  

American College of Surgeons (ACS) is American College of Surgeons (ACS) is founded at the urging of Franklin Martin, founded at the urging of Franklin Martin, M.D., a colleague of Dr. Codman. The M.D., a colleague of Dr. Codman. The “end result” system becomes an ACS “end result” system becomes an ACS stated objective.stated objective.

19171917

The ACS develops the Minimum The ACS develops the Minimum Standard for Hospitals. Requirements fill Standard for Hospitals. Requirements fill one page.one page.

19181918

The ACS begins on-site inspections of The ACS begins on-site inspections of hospitals. Only 89 of 692 hospitals hospitals. Only 89 of 692 hospitals surveyed meet the requirements surveyed meet the requirements

1926 1926

The first standards manual is printed The first standards manual is printed consisting of 18 pages.consisting of 18 pages.

19501950

The standard of care improves over time The standard of care improves over time and more than 3,200 hospitals achieve and more than 3,200 hospitals achieve approval under the program approval under the program

19511951

The American College of Physicians (ACP), the The American College of Physicians (ACP), the American Hospital Association (AHA), the American Hospital Association (AHA), the American Medical Association (AMA), and the American Medical Association (AMA), and the Canadian Medical Association (CMA) join with Canadian Medical Association (CMA) join with the ACS to create the Joint Commission on the ACS to create the Joint Commission on Accreditation of Hospitals (JCAH), an Accreditation of Hospitals (JCAH), an independent, not-for-profit organization whose independent, not-for-profit organization whose primary purpose is to provide voluntary primary purpose is to provide voluntary accreditation. accreditation.

19531953 JCAH publishes Standards for Hospital Accreditation.JCAH publishes Standards for Hospital Accreditation.

19701970 Standards are recast to represent Standards are recast to represent optimal achievableoptimal achievable

levels of quality, instead of minimum essential levels of levels of quality, instead of minimum essential levels of quality.quality.

Accreditation for hospitals and long term care facilities is Accreditation for hospitals and long term care facilities is reduced to a maximum of two years from three years. reduced to a maximum of two years from three years. Where survey findings indicated that necessary Where survey findings indicated that necessary improvements had not been made or completed, improvements had not been made or completed, accreditation is given for one year. accreditation is given for one year. 

1987 1987

The organization name changes to the Joint The organization name changes to the Joint Commission on Accreditation of Healthcare Commission on Accreditation of Healthcare Organizations to reflect an expanded scope of Organizations to reflect an expanded scope of activities.activities.

The Agenda for Change is launched with a set of The Agenda for Change is launched with a set of initiatives designed to place the primary initiatives designed to place the primary emphasis of the accreditation process on actual emphasis of the accreditation process on actual organization performance.organization performance.

19921992

The Accreditation Manual for Hospitals The Accreditation Manual for Hospitals begins the multiyear transition to begins the multiyear transition to standards that emphasize performance standards that emphasize performance improvement concepts.improvement concepts.

19961996

The Sentinel Event Policy is established for The Sentinel Event Policy is established for the evaluation of sentinel events in the evaluation of sentinel events in accredited organizations and their accredited organizations and their relationship to accreditation status.  relationship to accreditation status. 

IOM Report /1999IOM Report /1999

To Err Is Human:To Err Is Human:

Building a Safer Health care SystemBuilding a Safer Health care System

98,000 preventable deaths each year,with 98,000 preventable deaths each year,with an associated cost of $17 to $29 billion.an associated cost of $17 to $29 billion.

19991999 The Joint Commission’s mission statement is revised to explicitly reference patient safety:

"The mission of the Joint Commission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations

20012001

The Joint Commission forms a 20-member Standards Review Task Force to identify the accreditation standards most relevant to the safety and quality of patient care, and target for elimination or modification those standards that do not contribute to good patient outcomes. New standards that focus directly on patient New standards that focus directly on patient safety and medical/health care error reduction in safety and medical/health care error reduction in hospitalshospitals take effect July 1.  take effect July 1. 

20022002The Joint Commission establishes its first annual National Patient Safety Goals and associated requirements for improving the safety of patient care in health care organizations, to be effective in 2003.

Joint Commission President Dennis S. O’Leary, M.D., testifies before the House Committee on Energy and Commerce, Subcommittee on Health, on private sector efforts to improve patient safety  

20032003

The Joint Commission announces a Universal The Joint Commission announces a Universal Protocol™ for preventing wrong site, wrong Protocol™ for preventing wrong site, wrong procedure, wrong person surgery, effective procedure, wrong person surgery, effective July 1, 2004.  July 1, 2004.  The Joint Commission forms a 20-member The Joint Commission forms a 20-member expert panel to consider and recommend expert panel to consider and recommend ways in which the Joint Commission’s infection ways in which the Joint Commission’s infection control standards can be strengthened. Later control standards can be strengthened. Later in the year, the panel approves revised in the year, the panel approves revised standards that sharpen and raise the standards that sharpen and raise the expectations of organization leadership and of expectations of organization leadership and of the infection control program itself.the infection control program itself.

20042004

The World Health Organization launches The World Health Organization launches its World Alliance for Patient Safety in its World Alliance for Patient Safety in October, and the Joint Commission is October, and the Joint Commission is invited to be involved in several of the invited to be involved in several of the Alliance’s initiatives. Alliance’s initiatives.

20052005

Joint Commission President Dennis S. Joint Commission President Dennis S. O’Leary, M.D., testifies before O’Leary, M.D., testifies before Congressional leaders in June that Congressional leaders in June that American health care facilities must American health care facilities must embrace a embrace a “systems approach” to “systems approach” to preventing adverse eventspreventing adverse events that keeps the that keeps the errors that caregivers inevitably make from errors that caregivers inevitably make from reaching patients. reaching patients.

20052005

The World Health Organization in August The World Health Organization in August designates the Joint Commission and designates the Joint Commission and Joint Commission International as the Joint Commission International as the WHO Collaborating Centre for Patient WHO Collaborating Centre for Patient Safety Solutions.Safety Solutions.

20062006

The World Health Organization Collaborating The World Health Organization Collaborating Centre on Patient Safety, the World Alliance for Centre on Patient Safety, the World Alliance for Patient Safety and the Commonwealth Fund Patient Safety and the Commonwealth Fund announces a seven-country collaborative project announces a seven-country collaborative project in December that will leverage the in December that will leverage the implementation of five standardized patient implementation of five standardized patient safety solutions to prevent avoidable safety solutions to prevent avoidable catastrophic events in hospitalscatastrophic events in hospitals. .

20062006 JCI introduced the IPSGs in 2006 and surveyors have been JCI introduced the IPSGs in 2006 and surveyors have been

evaluating compliance with these goals during accreditation surveys evaluating compliance with these goals during accreditation surveys in 2006, but these findings have not affected the accreditation in 2006, but these findings have not affected the accreditation decision. Beginning 1 January 2007, hospitals accredited by JCI are decision. Beginning 1 January 2007, hospitals accredited by JCI are required to display compliance with the following ISPGs (in addition required to display compliance with the following ISPGs (in addition to JCI’s 368 standards in 11 chapters): to JCI’s 368 standards in 11 chapters):

Goal: Goal: Identify Patients CorrectlyIdentify Patients Correctly .. Goal:Goal: Improve Effective CommunicationImprove Effective Communication

Goal:Goal: Improve the Safety of High-alert Medications Improve the Safety of High-alert Medications

Goal:Goal: Eliminate Wrong-site, Wrong-patient, Wrong-procedure Eliminate Wrong-site, Wrong-patient, Wrong-procedure SurgerySurgery..Goal:Goal: Reduce the Risk of Health Care–acquired Infections Reduce the Risk of Health Care–acquired Infections

Goal: Goal: Reduce the Risk of Patient Harm Resulting from FallsReduce the Risk of Patient Harm Resulting from Falls

JoshuaJoshua GoldbergGoldberg1982-20061982-2006

Death of 23 year old sonDeath of 23 year old sonThis is a living case history This is a living case history

concerning the death of my 23 year concerning the death of my 23 year old son who died at Bumrungrad old son who died at Bumrungrad

Hospital in Bangkok Thailand on 23 Hospital in Bangkok Thailand on 23 February 2006 at approximately 9:00 February 2006 at approximately 9:00

PM, Thai time Yes, this is a case PM, Thai time Yes, this is a case about the death of a human being at about the death of a human being at the hands of malicious people. But it the hands of malicious people. But it is also a case which illustrates that is also a case which illustrates that money and power drives medical money and power drives medical care in the US and, by extension, care in the US and, by extension,

internationally.internationally. The last concern of thisThe last concern of this machinemachine is your health, care and safetyis your health, care and safety . .

Bumrungrad, the hospitalBumrungrad, the hospital where my son was where my son was murdered, murdered, is accreditedis accredited by the Joint by the Joint Commission.Commission.  Yet, despite having informed   Yet, despite having informed them, time and again, of factual wrong doing, them, time and again, of factual wrong doing, they have remained silent and have denied that they have remained silent and have denied that they have any responsibility to the public reveal they have any responsibility to the public reveal the the Accreditation: Once Given, Never Accreditation: Once Given, Never RevokedRevoked

Patient for patient safety Patient for patient safety MovementMovement

Leaded by Susan SheridanLeaded by Susan Sheridan

Lost her husband because of the health care Lost her husband because of the health care provided in accredited hospital,and her provided in accredited hospital,and her son is suffering of permanent disabilityson is suffering of permanent disability

patient safety awareness weekpatient safety awareness week

March 2March 2ndnd-- 2 2th. th. 20082008

In the Arab countriesIn the Arab countries? ?

Research in 2005 on the size of harm to Research in 2005 on the size of harm to patientpatient

WHO/EMRO,Dr.AHMAD ABDULATIF

Australian Research Center

Dr.Ross Wilson

The Arab Accreditation ProjectThe Arab Accreditation Project

Introduction on Why the project focus on patient Introduction on Why the project focus on patient safetysafety

Standards relevant to patient safetyStandards relevant to patient safety

المريض. رعاية معايير المريض. أ رعاية معايير أ

المريض. بب وسالمة أمان المريض. معايير وسالمة أمان معايير

اإلدارة.  معايير اإلدارة.  ج معايير ج

المجتمعية. الخدمات معايير المجتمعية. د الخدمات معايير د

Classification and scoring high lighting standard on Classification and scoring high lighting standard on patient safetypatient safety

التطابق : مستويات التطابق : رابعا مستويات رابعا

المبدئي المبدئي المستوى : :المستوى

معيار 75%75% مع معيار تطابق مع AA تطابق

معيار 50%50% من معيار تطابق من BB تطابق

المريض %85%85 آمان معايير مع المريض تطابق آمان معايير مع تطابق

االعتماد االعتماد مستوى : :مستوى

معيار 85%85% من معيار تطابق من AA تطابق

معيار 75%75% من معيار تطابق من BB تطابق

المريض 95%95% آمان معايير مع المريض تطابق آمان معايير مع تطابق