Outline
Health system needs for quality assurance and hospital accreditation System options for managing quality Hospital accreditation (HA) as regulatory incentive in Thailand
Some of major challenges for Thailands health care systems Inequity due to mal-distribution of health resources malIncreasing health care expenditure Introduction of close-ended payment mechanisms by closethe major health security schemes Expansions of business health sectors and the governmental Medical hub policies
Proposed Conceptual framework for the Master plan for managing quality under NHSS (Sriratanaban, et al. 2005) 2005) Promoting quality
Hospital accreditation
Correcting quality
Policy and management decision making
Resource s
Management systems for quality
Quality monitoring
Health services
Many countries in Asia have hospital accreditation programs, for example, Taiwan Korea Indonesia Japan Thailand Malaysia India (In certain states),
Thailand
Began 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 Collaboration for Hospital Quality Improvement and Accreditation Institute for Hospital Quality Improvement and Accreditation (HA-Thailand) (HATechnical support by external consultants from Canada (Adapted Canadian approach to HA) 35 pilot public and private hospitals
Quality hospital
RM
Resource management
[3], [4], [5], [6], [7]
Input
Output
Information and knowledge management Part IV Health care Patient and customer Financial Human resources Organization effectiveness Leadership and Social Health Promotion
Strategic planning
Staff focus
Part I
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
Accreditation Survey
Leadership interview Clinical and support staff and team interviews Patient and family interviews Observation of patient care and services provided Building tour and observation of patient care areas Review of written documents Review of patients medical records Evaluation of the organizations achievement of outcome measures
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
Potential impacts
Health system governance System design and development System financing Population health Knowledge management and transfer Clinical effectiveness Patient empowerment and decision-making decisionProfessional and personal development Management development Quality system development
Number of HA-accredited HAand HPH-certified hospitals HPH60 Number of new accredited or certified hospitals 50 40 150 30 100 20 10 0 Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan04 04 04 05 05 05 05 06 06 06 06 07 Time (Month / Year) HA HPH HPHA Acc.HA Acc.HPH Acc.HPHA 50 250 200 Accumulated number
Policy endorsement Leverage for accredited hospitals and other financial incentives Consideration in purchasing decisions Alignment of HA with other regulating mechanisms Program acknowledgement Program financing
Unclear purpose and unrealistic expectations Inappropriate technical approach Failure to involve stakeholders Lack of motivation (Provider) Poor cooperation among professional and governmental bodies