Building Public/Private Partnership for Health System Strengthening Thai Experience with Hospital Accreditation “ Thai Experience with Hospital Accreditation

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




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



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




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

Documents

Building Public/Private Partnership for Health System Strengthening Thai Experience with Hospital Accreditation “ Thai Experience with Hospital Accreditation