1. Hospital Accreditation Setting Standards
Kigali, Rwanda
DATE
Dr. Bonaventure NZEYIMANA
Ministry of Health
Tel: (+250)

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”.
Length of Time: 1 minute
Discussion Points:

3. What is quality?

4. Definition of quality Rwanda MOH, 2012
“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. Professional Competence Technical performance Coverage & utilization
Dimensions of quality
Professional Competence
Technical performance
Access to services
Effectiveness of care
Efficiency of service delivery
Interpersonal communication
Continuity of services
Safety
Physical infrastructure
Choice of services
Coverage & utilization

6. 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.”
Rwanda Ministry of Health
August 2008

7. SYSTEMIC VISION Inputs Processes Outcomes
Personnel: (HRH strategic plan with emphasis on specialized personnel)
Equipment: Modern equipment for referral hospitals
Supplies: Quality control for all supplies and consumables
Admission: Improved by standards
Test Procedures: 238 policies, procedures and guidelines
Patient Education: for the prevention and CHWs play major role
Treatment: Treatment guidelines developed and disseminated
Improved health status
Efficient services

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

9. 275
178
183
170
154
156
133
108
112
109 87 82 60 73 54 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
Cause
Timeframe
Decline in Mortality
Malaria (reported deaths)
2005 – 11
85.3%
HIV/AIDS (rate)
2000 – 09
78.4%
Tuberculosis (rate)
2000 – 10
77.1%
Child mortality (rate)
2000 – 11
70.4%
Maternal mortality (ratio)
60.0%
All-cause mortality (rate)
50.0%
Non Communicable diseases
????
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 Improving Quality Measuring QualityQA
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/ /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
Length of Time: 1 minute
Discussion Points:
Emphasize the highlighted elements within the definition.

16. Does it make a difference?
Accreditation -
Does it make a difference?
Length of Time: 15 seconds
Discussion Points:
Transition slide

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
Length of Time: 1 minute
Discussion Points:
Some studies have now been done to measure the impact of accreditation. Even though additional studies need to be done, there is evidence that accreditation does make a difference.

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