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

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:

What is quality?

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

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

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

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

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

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].

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].

Defining Quality Improving Quality Measuring Quality QA Improving Quality Measuring Quality

Rwandan Model to Quality Care Improvement Accreditation Universal Coverage PBF

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%)

Accreditation

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.

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

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.

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.

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