Hospital accreditation

Hospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”. Critically, accreditation is not just about standard-setting: there are analytical, counselling and self-improvement dimensions to the process. There are parallel issues around evidence-based medicine, quality assurance and medical ethics (see below), and the reduction of medical error is a key role of the accreditation process. Hospital accreditation is therefore one component in the maintenance of patient safety.

Broadly speaking, there exist two types of hospital accreditation

1) hospital and healthcare accreditation which takes place within national borders

2) international healthcare accreditation.

Background
Hospitals and healthcare services are vital components of any well-ordered and humane society, and will indisputably be the recipients of societal resources. That hospitals should be places of safety, not only for patients but also for the staff and for the general public, is of the greatest importance. Quality of hospitals and healthcare services is also of great interest to many other bodies, including governments, NGOs targeting healthcare and social welfare, professional organisations representing doctors, patient organisations, shareholders of companies providing healthcare services, etc. However, accreditation schemes are not the same thing as government-controlled initiatives set up to assess healthcare providers with only governmental objectives in mind - ideally, the functioning and finance of hospital accreditation schemes should be independent of governmental control.

How quality is maintained and improved in hospitals and healthcare services is the subject of much debate. Hospital surveying and accreditation is one recognised means by which this can be achieved.

It is not just an issue of hospital quality. There are financial factors as well. For example, in the USA, up until recently the Joint Commission exercised a de facto veto over whether or not US hospitals and other health providers were able to participate, and therefore earn from, the Medicare and Medicaid programs. This situation has changed in recent years.

National Hospital accreditation schemes
Accreditation schemes well-recognised as providers of national healthcare accreditation services include:

- Malaysian Society for Quality in Health, or MSQH - based in Malaysia

- Trent Accreditation Scheme, TRENT - based in UK-Europe and Hong Kong

- Australian Council for Healthcare Standards International, or ACHSI - based in Australia

- Accreditation Canada, formerly known as Canadian Council on Health Services Accreditation, or CCHSA - based in Canada

- Joint Commission (JC) - based in the USA

- Community Health Accreditation Program (CHAP) - based in the USA

- Accreditation Commission for Health Care Inc. (ACHC) - based in the USA

- The Compliance Team: "Exemplary Provider Programs" - based in the USA

- Healthcare Quality Association on Accreditation (HQAA) - based in the USA

- DNV Healthcare Inc. DNVHC - based in the USA

- Thailand Hospital Accreditation HA - based in Bangkok, Thailand

- Taiwan Joint Commission on Hospital Accreditation (財團法人醫院評鑑暨醫療品質策進會) - based in Taipei, Taiwan

The different accreditation schemes vary in quality, size, intent and the skill of their marketing. They also vary considerable in terms of the cost incurred by hospitals and healthcare institutions. They have varying degrees of commitment to assessing medical ethical standards and clinical standards.

They all have web sites.

International dimensions to Hospital Accreditation
Some accreditation schemes also undertake international healthcare accreditation work outside of their base country. One of the large number of accreditation schemes in the USA, the Joint Commission being the best known, has created Joint Commission International, or JCI.

The Trent Scheme was the first to accredit a hospital in Asia, in Hong Kong in 2000, and since then others, such as JCI, have entered the market.

The total costs incurred by hospital seeking JCI accreditation can be hard to establish, but may be considerable. In 2008, fees for a JCI survey are of the order of US$40,000-plus, to which surveyors' air fares, accommodation costs etc. much be added. There may also be additional costs related to consultancy work and mock surveys undertaken in preparation for being surveyed by JCI.