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This month’s edition of Healthcare Review – OnlineTM considers the important area of assessing health service standards.
Increasing demands for health service accountability and for cost-effective health services have prompted an expanded emphasis on quality practice and performance improvement in health care services.
Increasingly explicit and diverse guidance on clinical practice and service organisation continues to be developed but has had limited impact because of a lack of an effective means to ensure that such standards are implemented locally. Current proposals for statutory bodies in the United Kingdom National Health Service (NHS) focus on clinical practice rather than the clinical environment and management systems that require equally effective and complementary improvement mechanisms.
Dr Charles Shaw, Programme Director, CASPE Research, London, considers systematic approaches to linking national (or international) standards to local practice that were identified through the External Peer Review Techniques (ExPeRT) project, a European Union-funded research project to study external peer review systems in health services.
According to Shaw, these approaches to external improvement of health care organisations could help to embed evidence-based medicine and promote effective health service environments were they more integrated and consistent within and between countries. ’Countries will have to adopt common core standards and assessment processes if there is to be consistency and compatibility at national or international level.’
Shaw notes that an internationally agreed framework for defining and assessing standards for the organisation of health services is being developed by the International Society for Quality in Health Care (ISQua).
Mrs Lee Tregloan, CEO of the ISQua, reviews some of the evolution of accreditation of health care services into the international arena through the work of ISQua.
From an initial exchange between various national health care accreditation organisations, interest in aligning health care standards and accreditation processes internationally developed significantly. ISQua has emerged as a global entity with an international framework of principles and a peer assessment programme for national accreditation organisations. The project has become known as ISQua’s Agenda for Leadership in Programs for Healthcare Accreditation, ALPHA.
An international framework of principles developed by ISQua is used to guide the development and refinement of specific standards in use by various accrediting bodies worldwide. Tregloan outlines these internationally agreed principles against which eligible accreditation bodies can have their national accreditation standards assessed.
ISQua’s ALPHA programme uses this core set of principles and is the only global assessment and accreditation programme available to leading national standards and accreditation bodies in the health care sector.
Other ISQua projects include a significant project addressing indicators of clinical performance and the feasibility of establishing an international framework for such indicators.
The international structure and processes that have emerged with ISQua’s work represent landmark decisions that have the support of the majority of national and other special accreditation organisations worldwide.
John Wellingham, Clinical Manager, Networks, First Health, considers common frameworks for accreditation and the specific case of performance management in general practice in New Zealand.
Wellingham notes that the relationship of quality improvement to minimum standards, and the subsequent choice of indicators for these, has been a matter of considerable debate. He identifies a number of fundamental questions that have arisen as a result. These relate to balance between standards and continuous quality improvement (CQI) processes, determination of indicators and performance standards, and the ability to apply common standards across the health care industry and across national boundaries.
Wellingham considers each of these questions and debate that has taken place in relation to them.
He also considers certain of these issues against the background of the Shaw paper.
Wellingham agrees that benefits would arise from common assessment processes and core standards across countries resulting in consistency and compatibility at the national or international level, as set out in the Shaw paper. But Wellingham sees significant barriers to consistency of indicators, criteria and standards, and outlines what he believes could be achieved in terms of a common framework for accreditation processes
Wellingham then sets out processes that are in place to achieve consistency in accreditation processes in New Zealand general practice.
In conclusion, Wellingham acknowledges significant advances with accreditation including comprehensive input into standard setting. However, he believes that linkage between agreed standards and the process of continuous quality improvement has been hard to achieve.
