Hospital Accreditation Setting Standards

1. Hospital Accreditation Setting Standards Kigali, Rwanda DATE Dr. Bonaventure NZEYIMANA Ministry of Health nzeyimana.bonaventure68@gmail.com Tel: (+250) 788585815

2. Session Objectives • Identify the benefits of accreditation. • Recognize the importance of standards in improving performance. • Review quality concepts that provide the framework for standards development. • Describe the terms of reference of the Standards Task Force • Review the JCI “Essentials”.

3. What is quality?

4. 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

5. Dimensions of quality Professional Competence Technical performance Access to services Effectiveness of care Efficiencyofservicedelivery Interpersonalcommunication Continuity of services Safety Physical infrastructure Choice of services Coverage & utilization

6. Rwanda Ministry of Health August 2008 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.”

7. SYSTEMIC VISION

8. Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for Rwanda.

9. 275 183 178 170 154 133 156 112 108 109 87 60 82 54 73 59 63 52 53 51 29 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].

10. Towards reducing premature death in Rwanda 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].

11. Defining Quality QA Improving Quality Measuring Quality

12. Rwandan Model to Quality Care Improvement • Accreditation • Universal Coverage • PBF

13. 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%)

14. Accreditation

15. 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

16. Accreditation - Does it make a difference?

17. 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

18. 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.

19. Rwanda Essentials of Healthcare Quality and Safety Five Risk Areas • Leadership • Competent workforce • Safe environment • Clinical care • Quality improvement