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Building Public/Private Partnership for Health System Strengthening “ Thai Experience with Hospital Accreditation ” Ass oc . Prof. Jiruth Sriratanaban, M.D., Ph.D. Dept . of Preventive and Social Medicine , Faculty of Medicine, Chulalongkorn University Bali Hyatt Hotel, Sanur , Bali - PowerPoint PPT Presentation
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Building Public/Private Partnership for Health System Strengthening
“Thai Experience with Hospital Thai Experience with Hospital AccreditationAccreditation”
Assoc. Prof. Jiruth Sriratanaban, M.D., Ph.D.Dept. of Preventive and Social Medicine, Faculty of Medicine, Chulalongkor
n University
Bali Hyatt Hotel, Sanur, Bali21-25 June 2010
Thailand’s Health system
Development of Hospital Accreditation (HA) in Thailand
Hospital accreditation as a mechanism to regulate health care system and to promote public-private partnership
Population: 67 Million Rural: Urban Pop. = Top 3 killers: Health exp. As % of GDP: 3.3-3.5% Universal coverage: three compulsory
public schemes, i.e. CSMBS, SSS and NHSS (UC)
Public: Private exp. on health = 60:40
Groups of hospitals Number
Total
Public hospitals (2007) : 982
MOPH Community hospitals 730
MOPH General hospitals 70
MOPH Tertiary-care regional hospitals 25
MOPH Specialized hospitals in provinces (except BKK) 47
Other public hospitals in provinces (except BKK) 60
University / Medical-school hospitals 10
MOPH Tertiary-care hospitals / specialized institutions in BKK
18
Other public hospitals (e.g. Police, Military, BMA, etc.) 22
Private hospitals (2006) : 344
Private hospitals in BKK 102
Private hospitals in provinces (except BKK) 242
Inequity due to mal-distribution of health resources
Increasing health care expenditure
Introduction of close-ended paymentmechanisms by the major healthsecurity schemes
Expansions of business health sectorsand the governmental “Medical hub”policies
Increasing trend of patient complaints and lawsuits
Threatsagainst
quality of health care
Thailand’s Health system
Development of Hospital Accreditation (HA) in Thailand
Hospital accreditation as a mechanism to regulate health care system and to promote public-private partnership
Initiated 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
35 pilot public and private hospitals
Adapted Canadian approach (+ External consultant)
Collaboration for Hospital Quality Improvement and Accreditation
Developed into “Institute for Hospital Quality Improvement and Accreditation” under HSRI
Become “Healthcare Accreditation Institute (Public organization)” since 2009
Mechanisms to stimulate and facilitate hospitals to imMechanisms to stimulate and facilitate hospitals to improve quality in an organization-wide and systematic prove quality in an organization-wide and systematic
mannermanner
Accredit the hospital quality system
Accredit the hospital quality
PlanPlan DoDo
CheckCheckActActQualityhospital
HospitalHospital
CQI
Accredit
Accredit
QA/Standard
RM
First version of First version of HAHA S Standardstandards
ETH Patient rights & organizational ethics
GEN 8 Patient care & Service processes
Structure / Input Process Outcome
PatientOutcome
GEN 9 Quality programs e.g. RM, QA, CQI
GEN 2 Organization & management
GEN 1 Goals & directions
GEN 3 Human resources GEN 4 management and HUM development
GEN 7 Equipment
GEN 6 Facilities & ENV environment
GEN 5 Policy & procedures
IC Infection control
IM Information / Medical record
MED Medical staff organizationNUR Nursing administration
GOV GovernanceLED Leadership
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Governance and policy directions[1], [2]
Resource management[3], [4], [5], [6], [7]
Patient care process and services[10], [15], [16], [17], [18], [19], [20]
Analysis, measurement and improvement
[8], [9]
Patients and other customers
Professional systems,patient rights and
organizational ethics[11], [12], [13], [14],
Input Output
Health needs andcustomers’
expectations
Health outcomes,Satisfaction
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Source: Institute of Hospital Quality Improvement and Accreditation, THAILAND
Leadership
Strategic planning
Focus on patientsAnd Patient rights
Staff focus
Processmanagement
Results
Information and knowledge management
Key hospital systems
Risk, Safety and QualityProfessional managementEnvironmental managementInfection prevention and controlMedical record systemMedication systemMedical laboratory systemRadiological systemWork with communitiesPatient care processes
EntryPatient AssessmentPlanning (Care & Discharge)Care Delivery Patient & Family EmpowermentContinuity of Care
Health care Patient and customerFinancialHuman resourcesOrganization effectivenessLeadership and SocialHealth Promotion
Hospital and Health care
servicesStandards
2006
Part IV
Part III
Part II
Part I
Patient care processes
MBNQA/TQA Model
Selection and training of peer reviewers or surveyorsSupervision and ongoing education of surveyorsEducation and consultation about the standards to health care organizationsPre-survey processesDevelopment of a standardized evaluation methodology to assess standards performanceOn-site surveys (10-15,000 baht per man-day)Surveyor documentation and scoringPost-survey analysis of surveyor findings
Hospitals improve qualityHospitals improve qualityaccording to standardsaccording to standards
Hospitals completeHospitals completeHA self-assessmentHA self-assessment
Intensive consultation visitIntensive consultation visit(ICV)(ICV)
Accreditation surveyAccreditation survey
Accreditation decision by HA BoardAccreditation decision by HA Board
Training programs
Support networks
National forums
Manuals, documents,books, websites
Consultations
Example of Roadmap to HA:King Chulalongkorn Memorial Hospital
Commitment and common directionCommitment and common direction
Team / Staff / Supporting facilitiesTeam / Staff / Supporting facilities
Improve core Improve core processeprocessess
Expand to the whole organizationExpand to the whole organization
Pilot new activities / Expand the existingPilot new activities / Expand the existing
Fulfill to meet the hospital standardsFulfill to meet the hospital standards
Request for accreditationRequest for accreditation survey survey
Self assessment and internal surveySelf assessment and internal survey
1999
2002
Improvement ofImprovement ofpatient care processespatient care processes
Patient care teams (PCT)
New protocols for informed consent
Comprehensive patient assessments
Applications of clinical practice
guidelines, critical paths, care map
Customized self-helped groups and
individual health promotion programs
Intensive prevention and control for
hospital-acquired infection
New Discharge planning programs
Example of results ...Example of results ... Average length of stay : Shorter 28-day readmission rate : Decline Hospital-acquired infection: Decline Patient risk incidence : Fewer
serious
incidence Patient satisfaction : Higher Waiting time : Shorter
Accredited hospital means …Accredited hospital means … 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
0
50
100
150
200
250
300
350
400
Jan-04 Jan-05 Jan-06 Jan-07
Nu
mb
er
of
ho
sp
ita
ls
HA & HPH
HPH
HA
Thailand’s Health system
Development of Hospital Accreditation (HA) in Thailand
Hospital accreditation as a mechanism to regulate health care system and to promote public-private partnership
Licensure system for private providersThai Medical Council standardsQuality improvement programs by MOPH
Standards for infrastructure, 3-S program, TQM, ISO
The Social Security Office (1991)Health Care Facilities Act, B.E. 2542The Constitution of the country (1999 onward)The National Health Security Scheme
Improve quality of health care using the optimal set of hospital standards as guidelines
Patient safety and risk managementEvidence-based practiceContinuous learning and improvement
Stimulate and improve integration and management of health services
Strengthen the public’s confidence
Hospital accreditation is an education process, not an inspection
Let’s make it together Bring the professional organizations into
the field. Create opportunities for performance-
based incentives
Inter-hospitalQuality conference
On-site Process benchmarking and
consultation
Meetings for experience sharing
and training
Web-based andPaper-based
Supporting documents
External (Accreditation)survey
Hospitals2004 2005 2006 2007
Staff Sites Staff Sites Staff Sites Staff Sites
Tertiary-care
189 11 267 10 204 12 346 17
General 753 58 746 51 676 48 890 52
Community 850 170 1527 223 1587 198 1997 280
University (teaching)
525 18 583 16 607 18 336 21
Private 610 100 618 80 719 90 990 128
Military 193 28 175 12 212 22 300 28
Mental 86 8 71 7 100 9 98 10
Total 3,206 393 3,987 399 4,105 397 4,957 536
Policy formulation
Standard writing
Implementation of clinical practice guidelines
Accreditation decisions and recognition
Linkage to professional training
Social Security Scheme endorsement of HA◦ Special quota of registered beneficiaries for
accredited providers◦ Additional per-head payment for accredited
hospitals National Health Insurance Scheme movement
◦ Financial support for HA consultation programs ◦ Financial bonus for accredited providers
Impacts for national health service systems◦ Health promoting hospital◦ Use of evidence-based practice◦ Disease management programs by NHSO◦ Humanized health care initiatives
Is there an opportunity to use a hospital accreditation program to promote public-private partnership?
How can a hospital accreditation program support a system policy on public-private partnership?
Promote standardized requirements for optimal hospital performance
Create environment for partnership◦Platform in policy formulation◦Public-private co-operation in improving care◦Knowledge sharing activities
Ensure quality and strengthen public confidence
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